HAND INSTRUMENTS IN

OPERATIVE DENTISTRY

By:-
Dr Abhijeet D Khade
Nair Hospital Dental College,
Mumbai
INTRODUCTION
 The term “instrument” refers to a tool, device or
implement used for specific purpose or type of work and
is preferred in professional or scientific fields as
precision items are generally required to perform
specific procedures.

 In order to perform, the intricate or detailed procedures

associated with operative dentistry, the dentist must
have a complete knowledge of the purpose and
application of the many instruments required.
 The instruments available.
 The purpose of the instrument.
 The position or manner of use.
 The application of the instrument.
 HISTORY
 Most hand instruments of the mid 19th century(1860‟s)
with large, heavy handles and inferior metal alloys in the
blade, were cumbersome, awkward to use and ineffective.
 These instruments had bone or ivory handles (effective
sterilization was not possible).
 There was no uniformity of manufacture and
nomenclature.
 Many dentists made their own hand instruments in an
effort to find a suitable instrument for specific need.
 Early hand instruments were grasped in the palm of the
hand.
 As cavity preparations refined and the access to various
surfaces of teeth desired:-
- Grasp changed to pen grasp.
- Instrument with large, straight blades
modified to smaller, angled blades.
 Dr. G.V. Black - Credited with the first acceptable
nomenclature for and classification of hand instruments.
Dr. Arthur D. Black - Developed many of the instruments
and techniques.
 Dr. Charles E. Wood Bury -
First to modify blacks instrumentation.
Designed 39 sets of Hand instruments for Class III cavity
preparations & condensing points for building gold foil
restorations.
 Dr. Wedelstaedt - Developed Wedelstaedt chisel now
referred to as “Curved Chisel”.
 Dr. Waldon I. Ferrier – Developed a new set of instruments
called ferrier set which were more refined and had uniform
thickness on the cutting edge.
 Dr. George Hollenback – Invented pneumatic condenser.
MATERIALS USED

Hand cutting instruments are

manufactured from two main materials:
 Stainless steel
 Carbon steel
 Some instruments are made with carbide
inserts to provide more durable cutting
edge.
- Hard and wear resistant but is brittle
too.
Stainless steel Carbon steel Stellite
Chromium 18% Carbon 1 – 1.2% Cobalt 65 – 90%
Carbon 1% Manganese 0.2% Chromium 35%
Iron 81- 81.4% Silicon 0.2% Trace amounts :
Adv.:- Iron 98.4 – 98.6% tungsten, molybdenum
- Chromium in the alloy Adv.:- and iron.
reduces the corrosion
tendency by depositing an
- Harder than Adv.:-
oxide layer on the surface of stainless steel. - High resistance to
the metal. Disadv:- acid
- Remains bright under - When unprotected, - Hardness
most conditions. it will corrode. Use: Manufacture of
Disadv:- mixing and inserting
- Maintaining the instruments.
sharpness of the blade is a
problem.
- Loses a keen edge during
much use.
Mainly used for
working points and cement
instruments.
 Other alloys:
 Alloys of nickel, cobalt or chromium are used in the
manufacture of hand instruments.
PARTS OF HAND INSTRUMENTS

 Handle/ Shaft
 Shank
 Blade with cutting
edge or Nib with face.
MANUFACTURING PROCESS

 Blank steel is bent to the degree of angulation

needed in the shank and blade.
 The edges are milled to produce the cutting
edge and structural design.
 Martensitic type of stainless steel is used for
manufacturing cutting instruments (high
strength and hardness).
 HEAT TREATMENT
HARDENING TREATMENT TEMPERING TREATMENT

 The steel is heated to 1500 to 16000  Cutting edges are usually

tempered to produce additional
F (8150 C) and then quenched in oil
hardness and to remove some
to harden the working edge. of the brittle properties.
 Not more than 1 - 2mm of the tip  To accomplish this, the tip is
is heated for hardening purpose, reheated at a lower
otherwise the instrument will lose temperature.
its balance after sharpening.  Quenched in solutions of oil,
 Hardens the alloy, but it also acid or mercury at 200- 4500C
makes it brittle, especially when for 10 min.
the carbon content is high.  This treatment relieves strains
and increases toughness.
 CLASSIFICATION
I. ACCORDING TO STURDEVANT:
 Cutting (Excavators, Chisels and others)
 Non-cutting (Amalgam condensers, mirrors, explorers,
probes)

 Excavator : CHISELS : Others :

-Ordinary Hatchets -Straight chisel -Knives
-Hoe -Curved chisel or -Files
-Angle former Wedelstaedt chisel -Scalers
-Spoon excavator -Bin angle chisel -Carvers.
-Enamel hatchet
-Gingival marginal
trimmers
II. ACCORDING TO CHARBENAU
1. Cutting instruments 2. Condensing Instruments
Hand Pluggers
- Hatchets - Hand
- Chisel
- Hoe - Mechanical
- Excavator 3. Plastic Instruments
- Others - Spatulas
Rotary - Carvers
- Burs - Burnishers
- Stones - Packing Instruments
- Disk
- Others
4. Finishing and 5. Isolation Instruments
Polishing Instruments - Rubber dam frame
Hand Clamps
- Orange wood sticks Forceps
- Polishing points Punch
- Finishing strips - Saliva ejectors
Rotary - Cotton roll holders
- Finishing burs - Evacuating tip and
- Mounted brushes equipments
- Mounted stones
6. Miscellaneous
- Rubber cups
- Impregnated disk Instruments
and wheels - Mouth Mirrors
- Probe
- Scissors
- Pliers
- Others
 III. ACCORDING TO MARZOUK:
1. Exploring or diagnostic 3. Hand cutting instruments:
instruments: - Excavators
- Mouth mirror - Spoon excavator
- Explorer or probe - Cleiod
- Straight probe - Discoid
- Right angled probe - Hatchet excavator
- Arch shaped - Hoe
(Shepherds hook) - Chisels
- Interproximal - Straight chisel
(Back action) - Mono angle chisel
- Tweezers - Bin angle chisel
- Seperators - Triple angle chisel
- Cheek retractors - Special types of chisels or
- Air syringe modified chisels
2. Isolating instruments: - Wedelsteadt chisel
- Cotton roll holder - Enamel hatchet
- Rubber dam - Gingival marginal
- Saliva ejector trimmer
- Suction apparatus - Angle former
4. Restoring instruments: - Carving instruments
- Mixing instruments - Hollenback carver
- Cement spatula - Diamond carver
- Agate spatula - Wards carver
- Plastic carrying/ filling 5. Miscellaneous
instruments instruments:
- Packing instruments - Matrices and
- Amalgam carrier retainers
- Condensing instruments - Scissors
- Round condenser
- Parallelogram condenser
- Burnishing instruments
- Ball shaped
- Egg shaped
- Conical shaped
PARTS OF HAND INSTRUMENTS

 Handle/ Shaft
 Shank
 Blade with cutting
edge or Nib with face.
 HANDLE/ SHAFT
 Length – 5.5 inches
 Diameter – 5.5 mm
 Available in various sizes and shapes (small,
medium & large diameter).
 Hexagonal or octagonal.
 Smooth, serrated or knurled.
 Knurled to facilitate control and to increase
the friction for hand-gripping.
 Instrument formula incorporated on it.
 Manufacturing kit number incorporated on it.
 Handle is either continuous with shank or
separable.
 SHANK
 Connects the handle to
the blade or nib.
 Smooth, round, tapered
and contrangled.
 Have one or more bends
to avoid the instrument
from having tendency to
twist in use where force
is applied.
 [Link] classified
instruments depending
on the number of angles
in the shank as:-
Mon- angle
Bin- angle DIFFERENT SHANK DESIGNS
Triple- angle
Quaternary angle
NOMENCLATURE
In establishing a nomenclature for hand
instruments, Dr G.V. Black prescribed four classes similar
to biological classification:

ORDER: Purpose of the instruments

SUBORDER: Position or manner of use
CLASS: Form of working end
SUB CLASS: Shape of the shank

Bin-angle hatchet push excavator.

 BLADE

 Functional end of the instrument that

bears the cutting edge.
 It is connected to the handle by the
shank.
 For non-cutting instruments, the part
corresponding to the blade is termed
“Nib”.
 Working surface or the end of the nib
is known as the “face”.
 Cutting edge
 Beveled:-
- Single beveled
- Bibeveled
- Triple beveled
(1 primary and 2
secondary bevels).
- Circumferentially
beveled
 Regular bevel:
- Distal to shaft
 Reverse bevel:
- Mesial to shaft
e.g. – Binangle chisel BLADE BEVELS
 INSTRUMENT FORMULA
GIVEN BY [Link]:
 3 unit instrument formula:
Cutting edge of the
instrument is at a right
angle to the blade.
a. First unit – Width of the
blade in tenths of a millimeter.
b. Second unit – Length of the
blade in millimeter.
c. Third unit – Angle the
blade forms with the axis Instrument formula of enamel
of the handle in centigrade. hatchet.
4 unit instrument formula: Cutting edge of the instrument is
at an angle other than a right angle to the blade.

a. First unit – Width of the blade

in tenths of a millimeter.
b. Second unit - Angle the cutting
edge forms with the axis of the
handle in centigrade.
c. Third unit – Length of the
blade in millimeter.
d. Fourth unit – Angle the blade
forms with the axis of the
handle in centigrade.

Example:- Gingival marginal

trimmer & angle former. Instrument formula of distal GMT
 MEASURING GAUZES

BOLEY‟S GAUZE

CENTIGRADE SCALE
MEASURING ANGLE OF THE BLADE AND CUTTING EDGE
Types of hand cutting instruments
 Chisels:-
- Cutting edge of the instrument is
at a right angle to the axis of the
instrument.
- Used for planing or cleaving
enamel.
1) Straight chisel:-
- No bend in shank
- Single beveled/ Triple beveled.
- Minimal accessibility.
- Used with push stroke or lateral
scraping action.
2) Mono angle chisel:-
- Blade is shorter as compared to
straight chisel.
- Single angle in the shank to
enhance the convenience form.
- Used with push stroke or lateral
scraping action.
 Hatchet:-
- Cutting edge of the instrument is
parallel to the axis of the instrument.
- Cutting edge of the instrument is at
right angle to the axis of blade.
- Mono angled
- Length of blade is very small
- Bibevelled
- Single ended
- Used with push stroke

Use:-
- Preparing retentive areas on anterior
teeth.
- Sharpening internal line angles in DFG
restorations.
 Enamel hatchet:-
- Cutting edge of the instrument
is parallel to the axis of the
instrument.
- Cutting edge of the instrument
is at right angle to the axis of
blade.
- Binangle hatchet
- Monobeveled
- Single plane instrument
- Paired instrument
- Bevel on right side – Right side
instrument
- Bevel on left side – Left side
instrument
 Used with push stroke (planing or
direct cutting motion as well as lateral
cutting motion).
 Used for smoothening buccal and
lingual walls of proximal box.
 Used for breaking enamel of proximal
box.
 Used for smoothening gingival seat
(lateral scraping motion).
 Gingival marginal trimmer:-
- Cutting edge of the instrument
is parallel to the axis of the
instrument.
- Cutting edge of the instrument
is at an angle other than a right
angle to the blade.
- Modified hatchet
- Binangle instrument
- Monobeveled
- Double plane instrument
(better lateral scraping efficiency/
scooping effect).
 Spoon excavator:-
- Modified hatchet.
- Double ended instrument.
- Binangle/ Triple-angle
instrument.
- Paired (right and left).
- Double plane instrument.
- Circumferentially beveled.
- Cutting edge either circular
(discoid) or claw like (cleoid).
Use:- Spooning or scooping of
softened carious material.
- Carving amalgam or direct DIFFERENT SPOON EXCAVATOR
wax patterns.
 Other instruments:-
 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.
 Files:-
 Used for smoothening of overhanging
restorations (amalgam and gold).
 Non cutting instruments
 Diagnostic instruments:-
1) Mouth mirror:-
- Is an instrument having a mirror head top and a detachable
handle.
- Also called as odontoscope.
Types:-
A) Front surface:-
- Is one where the reflecting surface is on the top of the glass
piece.
- Gives better visibility.
- Absence of intervening glass.
- No double image.
- Mercury coating on top is liker to be lost due to
scratching.
B) Rear surface (regular)
- Reflecting surface is on the back surface of the mirror lens.
- Surface is less easily scratched.
- Produces a double or ghost image.
C) Magnifying mirror (concave):-
- Reflecting surface is on the front surface of the
mirror lens.
- Produces magnified but slightly distorted image.
- Concave surface mirror magnifies the image,
requiring the clinician to learn to accommodate
movement.
- Concave mirror rarely used except for seeing enlarged
internal details of the cavity.
- The instrument movements are smaller than the
clinician visual perception.
- For endodontic surgeries.
D) Disposable mirror:-
- Made of plastic.
 Uses:-
Indirect illumination.
- Mouth mirror could be held at an angle to reflect the light
onto the working area.
Retraction
- Mirror head used to retract the patient‟s lip or check or
tongue so that the clinician is able to view tooth surfaces.
Protects from injury.
Indirect vision.
Guard.
Trans illumination.
- Only maxillary and mandibular anterior teeth can be
trans illuminated.
 Different sizes of mouth mirror:-
No. 2 (5/8 inch)
No. 4 (7/8 inch)
No. 5 (15/16 inch)
FRONT SURFACE AND DIFRFERENT SIZES NO. 2,4,5.
REAR SURFACE MIRROR
2) Probe:-
- Sharp pointed hand instrument used to
explore teeth and restoration surfaces in order to
detect caries, overhanging edges and other
defects.
- May be single-ended or double-ended.
Uses:-
- Exploring lesion
- For detecting and assessing carious lesion in
the tooth
- Detecting demineralized dentin.
- Releasing debris from the tooth.
- Removing slight excess fill up around
cavo-surface margins
- Identifying hypersensitive areas in the tooth
- Assessing marginal fit of the restoration
 Types:-
- Straight.
- Interproximal probe
- No.2 cow horn
(arch explorer)
- No.17 back action
- No. 23 shepherd‟s
hook
- Orban –type
explorer

Different types of explorers

3) Periodontal probe:-
- Detect and measure
the depth of
periodontal pockets.
- In operative
dentistry:- Used to
determine the
dimensions of
instruments and of
various features of
preparations or
restorations.
4) Forceps:-
- Tweezers/ Cotton forceps
- Hemostats
- Articulating paper forceps
Tweezers:-
- Hand instrument with two narrow and
pointed, straight or curved beaks used to
grasp small objects.
Consist of:-
- 2 long arms.
- Locking device.
- 2 long arms joined at one end.
- Other end remains apart.
Uses:
- Useful in carrying things to and from mouth.
- Carrying cotton rolls, cotton pledges, sponge pellets to
and around the cavity.
- Carrying saliva soaked cotton rolls from the oral cavity
to the waste disposal unit.
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 whatever is
carried by the tweezer.
TWEEZERS ARTICULATING PAPER FORCEPS

HEMOSTATS
 Restoring instruments:-
1) Mixing instruments:- Cement spatula
Spatulas:-
- Flat and wide nibs with blunt edges.
- Shank straight.
- Different sizes and different degrees
of stiffness in their nibs to suit their
various uses.
Made of
○ Stainless steel.
○ Plastic.
- Doubles ended instrument.
Blunt end – for manipulating
impression materials.
Sharp end - for mixing cements.
- Used for manual mixing of cements
supplied as powder and liquid.
2) Plastic carrying/ filling instruments:-

 It is an instrument used for carrying the mixed base

cements which are in soft (plastic) stage or the
restorative cement from a cement spatula to the
cavity.
 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.
 Made of: - Stainless steel
- Plastic
 Also can be plated with teflon to minimize material
adhesion.
 STAINLESS STEEL
“PLASTIC”
INSTRUMENTS

TITANIUM NITRIDE
INSTRUMENTS FOR
PLACING AND SHAPING
COMPOSITE
3) Packing instrument:-
Amalgam carrier:-
Amalgam carrier is a
stainless steel instrument
used for carrying mixed
amalgam to the cavity.
Use:-
-Hollow tip of an amalgam
carrier is inserted into the
mixed amalgam to pack the
carrier with amalgam.
-It is then carried into the
cavity and plunger is pressed
injecting cylindrical pellets of
amalgam.
4) Condensing instruments.
- To pack material into prepared cavity.
- Types:
A) Amalgam condenser
- Hand
- Mechanical – Vibratory and Impact type
B) Gold condenser
- Hand
- Mechanical.
 Hand condenser:-
- Are double-ended instruments with the nibs
(condensing tips) coming in different size and
shapes.
- Force varies inversely with the area of the face.
 Nibs may be:-
I) Of different shapes:-
Round
Elliptical
Diamond
Triangular
Parallelogram
Rectangular
II) Sizes vary considerably;
Large round condenser
Small round condenser
III) Depending on working end;
(condenser face). DIFFERENT TYPES OF
Serrated – For spherical AMALGAM CONDENSERS
amalgam
Non-serrated (smooth) – For
admixed amalgam
5) Burnishing instruments:-
 Hand instrument with rounded
edges used to polish or burnish the
surface of metallic restorations by
rubbing.
 Burnishing is the process of
rubbing usually performed to make
a surface shiny or lustrous.
 Double-ended.
 Nibs are spherical.
 Ball shaped.
 Egg shaped.
 Apple shaped.
 Beaver tail shaped.
 Conical.
 Hour glass
 Fish tail.
 Bullet shaped etc.
DIFFERENT TYPES OF BURNISHERS
 Nibs are smooth-faced.
 Different angulations and curvature in their shank.
 Amalgam burnishers
- Small ball burnisher.
- Beaver tail or egg burnisher.
- Anatomic burnisher.

Other uses:-
- Shape metal matrix bands so that they
impart more desirable contours to
restorations.
- To “bend” cast gold near the margins to
narrow the gap between the gold and the
tooth (beaver tail).
6) Carving instruments:-
- Hand instrument with a blade
or nib used to contour the surface
of filling material in their plastic
state, waxes, models and
patterns.
e.g.- Hollenback carver (Knife-
edged-elongated bibeveled)
- Diamond (Frahm‟s) carver –
Bibeveled cutting edge DIFFERENT TYPES OF
- Wards „C‟ carver AMALGAM CARVERS
- Discoid- cleoid
- Interproximal carver
 Hollenback, Diamond and
Wards - One blade is parallel
to the long axis of the
instrument and the other is
perpendicular to the long
axis of the instrument.
CLEOID (TOP) AND DISCOID
(BOTTOM) CARVERS
HAND INSTRUMENT TECHNIQUES
 Instrument grasps:-
Definition:- 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.
Adv:- Instrument can be held in different areas for
maximum comforts of the operator.
- Better operator efficiency.
 Different grasps:- 1) Pen grasp (Not an acceptable grasp)
2) Modified pen
3) Inverted pen Used universally
4) Palm and thumb
5) Modified palm and thumb
 Pen grasp:-
- Instrument is held between thumb and first
finger with middle finger below acting as a support.
- Either the third or third and fourth fingers are placed
on adjoining tooth as rest.
- Position of middle finger is important –
1) For obtaining thrust
2) Preventing the instrument from
slippage during manipulation.
- It involves wrist movement.
Adv:- -More flexibility of movement.
-Less power.
-Greatest versatility of movement.
-More comfortable.
-Limits application of pressure.
Disadv:- Bracing is difficult because only the ring
and little fingers are used.
 Modified pen grasp:-
- Permits greatest delicacy of touch.
- Pads of thumb, index and middle finger 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 for good control and cutting
pressure.
- The fingers and the thumb engage the instrument as a
grappling hook.
- The base of the index finger and the tip of the middle
finger reciprocate, with the thumb placed midway
between them.
- The palm of the hand generally faces away from the
operator.
- Involves forearm which turns inward (pronates) or
outward (supinates).
 Adv:- - More effective
- Controlled power to the instrument.
 Inverted pen grasp:-
- The palm is rotated upwards with the pad
of the thumb and index fingers close to each
other but the middle finger is farther down
the shank.
- Used mostly for the tooth preparation
utilizing the lingual approach on maxillary
anterior teeth.
 Palm and thumb grasp:-
- The handle of the instrument is held between
the palm and four fingers firmly with the tip
of the thumb acting like a rest.
- Power grasp.
 Adv:-
- More control and precision.
- Limited movement.
- Enhance bracing (a forward thrust with the
arm of wrist can be controlled by the
opposing
action from the thumb, which is braced
against the teeth).
- Gives the possibility of applying pressure
precisely.
Example: holding a hand piece for cutting incisal
retention for Class III preparation on maxillary incisor.
 Modified palm and thumb grasp:-
- The handle of the instrument is held by all four
fingers whose pads press the handles against the
distal area of the palm, as well as the pad and
first joint of the thumb.
- The rest is tip of thumb on tooth being prepared
or adjacent teeth.
Adv:-
- Most valuable aid in operating inside and outside
the mouth.
- Allows greater ease of instrument movement.
- More control against slippage during thrust
stroke compared to palm and thumb grasp.
- Grasping the handle under the first joint of the
ring and little finger acts as a stabilizer.
- More delicate manipulation.
PEN GRASP AND MODIFIED PEN GRASP INVERTED PEN GRASP

PALM AND THUMB GRASP MODIFIED PALM AND THUMB GRASP

Rest:-

 Is to stabilize the hand and instrument by

providing a firm fulcrum as movement are made
to activate the instrument.
 Is required for steady hand during operative
procedures.
Adv:-
 A good finger rest prevents injury and laceration
of the gingiva and surrounding tissues.
 The ring finger is preferred as finger rest.
 When modified pen and inverted pen
grasps are used, rests are established by
placing the ring or ring and little fingers
on a tooth (or teeth) of the same arch and
as close to the operating site as possible
(more reliable).
 In palm and thumb grasp, rests are
created by placing the tip of the thumb on
tooth being operated on, or on an adjacent
tooth, or on a convenient area of the same
arch.
 When it is impossible to establish a rest
on tooth structure, soft tissue must be
used (not reliable).
Finger rests classified
 Intra oral finger rest
 Extra oral fulcrum
Intra oral finger rest:-
1. Conventional
Finger rest is established on the tooth surfaces
immediately adjacent to the working area.
2. Cross- arch
Finger rest is established on the tooth surfaces on
the other side of the same arch.
3. Opposite-arch
Finger rest is established on tooth surfaces on the
opposite arch (e. g:- mandibular arch finger rest for
instrumentation on the maxillary arch).
4. Finger – on – finger.
Finger rest is established on the index finger or
thumb of the non operating hand.
Extra oral fulcrums.
Two most commonly used-
(1) Palm-up.
Palm-up fulcrum is established by resting
the backs of the middle and ring fingers on the
skin overlying the lateral aspect of the
mandible on the right side of the face.
(2) Palm-down
Palm- down fulcrum is established by
resting the front surfaces of the middle and
ring fingers on the skin overlying lateral aspect
of the mandible on the left side of the face.
Extraoral palm-up hand rest. Palm is
facing out, away from the patient's face.
Extraoral palm-down hand rest. Palm is
facing in, toward the patient's face.
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.
 DETECTION OF A DULL CUTTING INSTRUMENT
1) Visibility of a reflection off the cutting edge.
Sharp edge – not reflect light
Dull edge – reflect light/ presence of a “glint”.
2) Obvious irregularities in the cutting edge
3) Won‟t shave thumb nail.
4) Won‟t cut tooth structure.
 Instruments with dull cutting edge causes:-
- More pain
- Prolong operative time
- Less controllable
- Reduce quality and precision in tooth
preparation
 Goal of sharpening instrument
- Maintain and restore a knife like cutting
edge
- Preserve the shape and proportional
dimensions of the instrument
- Increase work efficiency of the instrument