Periodontal instrument

[Link] Husham

Periodontal instruments are designed for specific purposes, such as removing calculus,
planning root surfaces, curetting the gingival wall or removing disease tissues.
Periodontal instruments composed of:
a. Blade
b. Shank
c. handle

classification of periodontal instruments

A. diagnostic instruments
1. dental mirrors used for Specific uses
❖ Indirect vision
❖ Indirect illumination
❖ Transillumination
❖ Retraction
Nonspecific uses
Handles can be used for checking mobility and and percussion.

2. Periodontal probes are used to locate ,measure and mark pockets and
determine their course on individual tooth surfaces.
A typical probe is a tapered rod-like instrument calibrated in millimetres with a
blunt, rounded tip. Types of periodontal probes
• Color-coded
• Noncolor-coded

a. UNC-15: The probe markings from 1 to 15

.
b. The Marquis color-coded probe: The calibrations are in 3 millimeter sections.

c. The WHO probe: It has a 0.5 mm ball at the tip and millimeter marking at
3.5, 8.5 and 11.5 mm and color coding from 3.5 to 5.5 mm

When measuring a pocket, the probe is inserted with firm, gentle pressure to the
bottom of the pocket. Several measurements are made to capture the level of
attachment along the surface of the tooth.
3. Explorers: are used to locate calculus deposits and caries. They are also used
to locate subgingival deposits in various areas, and to check the smoothness
 of the root surfaces after root planing. Explorers are designed with different
shapes and angles for a variety of use.

B. Scaling ,root planing, and curettage instruments

They are classified as follows:
a. For supra gingival scaling which includes: Sickle scalers, cumine, push
scalers
1. Sickle scalers have a flat surface and two cutting edges that converge in a
sharply pointed tip. The arch shape of the instrument makes the tip so strong that
it will not break off during use. They appear triangular in cross-section. The
sickle scaler is inserted under ledges of calculus no more than 1 mm below the
gingival sulcus. It is used with a pull stroke. Sickles with straight shanks are
designed for use on anterior teeth and [Link] scalers with contra-
angled shanks adapt to posterior teeth.
 2. Cumine : A hybrid (double ended) instrument – one end is a “spoon” curette -
the other is a heavy duty tooth scaler. It is hook-like having a simple curved
shape without offset which tapers to a sharp point.
Uses

Both ends can be used to dislodge thick calculus deposits to allow visualization of the
crown.
Scaler end; to remove heavy supragingival calculus deposits from interproximal area.
Curette end or spoon end gentle curettage of large sockets to remove the granulation
tissue (if present), removal of soft tissues from sites of bony pathology e.g. to clean out
the bony defect in debridement of bone cyst lesions. also used to clean labial and
lingual surfaces from calculus

3. Pushing scaler :These have been designed for the proximal surfaces of
teeth and primarily used in the anterior areas.

b. For subgingival scaling :

● Hoe scaler ,are used to remove tenacious subgingival deposits, Hoe scalers are
used for scaling of ledges or rings of subgingival calculus. The blade is bent at a
99-degree angle; the cutting edge is formed by the junction of the flattened
terminal surface with the inner aspect of the blade. The blade has been reduced to
 minimal thickness to permit access to the roots without interference from the
adjacent tissues.

Hoe scalers are used in the following manner:

1. The blade is inserted to the base of the periodontal pocket so that it makes
twopoint contact with the tooth. This stabilizes the instrument.
2. The instrument is activated with a firm pull stroke toward the crown, with every
effort being made to preserve the two point contact with the tooth
● Curettes The curette is the instrument of choice for removing deep subgingival
calculus, root instrumentation (root planing) of altered cementum, and removal of
the soft tissue lining the periodontal pocket. Each working end has a cutting edge on
both sides of the blade and a rounded toe. Curettes are finer than sickle scalers and
do not have any sharp points or corners other than the cutting edges of the blade.
Therefore, curettes can be adapted for and provide good access to deep pockets,
with minimal soft tissue trauma.
Types of curates
● Universal curettes have cutting edges that may be inserted in most areas of the
dentition by altering and adapting the finger rest, fulcrum, and hand position of the
operator
● Gracey curettes are representative of the area-specific curettes, a set of several
instruments designed and angled to adapt to specific anatomic areas of the dentition
Double-ended Gracey curettes are paired in the following manner:
Gracey #1-2 and #3-4: Anterior teeth
Gracey #5-6: Anterior teeth and premolars
Gracey #7-8 and #9-10: Posterior teeth, facial and lingual
Gracey #11-12: Posterior teeth, mesial
Gracey #13-14: Posterior teeth, distal
Extended-Shank Curettes. Extended-shank curettes, such as After Five curettes
(Hu-Friedy, Chicago, IL), are modifications of the standard Gracey curette design.
The terminal shank is 3 mm longer, allowing extension into deeper periodontal
pockets of 5 mm or more. Other features of After Five curettes include a thinned
blade for smoother subgingival insertion and reduced tissue
Mini-Bladed Curettes. Mini-bladed curettes, such as Hu-Friedy Mini Five curettes,
are modifications of the After Five curettes. Mini Five curettes feature blades that
 are half the length of After Five or standard Gracey curettes. The shorter blade
allows easier insertion and adaptation in deep, narrow pockets; furcations;
developmental grooves; line angles; and deep, tight facial, lingual, or palatal
pockets. In any area where root morphology or tight tissue prevents full insertion of
the standard Gracey or After Five blade, Mini Five curettes can be used with
vertical strokes, with reduced tissue distention and no tissue trauma.
Micro Mini Five Gracey curettes (Hu-Friedy, Chicago, IL) have blades that are
20% thinner and smaller than the Mini Five curettes These are the smallest of all
curettes, and they provide exceptional access and adaptation to tight, deep, or
narrow pockets; narrow furcations; developmental depressions; line angles; and
deep pockets on facial, lingual, or palatal surfaces

Dental Endoscope The dental endoscope is used subgingivally in the diagnosis and
treatment of periodontal disease. It permits operators to detect the presence and
location of subgingival deposits and guides them in the thorough removal of these
deposits. Magnification ranges from 24 to 48 times, enabling visualization of even
minute deposits of plaque and calculus. Using this device, operators can achieve levels
of root debridement and cleanliness that are much more difficult or impossible to
produce without it. The dental endoscope can also be used to evaluate subgingival
areas for caries, defective restorations, root fractures, and resorption.

Sonic and ultrasonic instruments. Used for removing plaque, scaling, curetting
and removing stains
Two types of ultrasonic units are:

• Magnetostrictive: Vibration of the tip is elliptical; hence all the sides can be
used.
• Piezo-electric: The pattern of vibration of the tip is linear; only two sides of
the tip are active.
Ultrasonic vibrations range from 20,000 to 45,000 cycles/second. They operate in a
wet field and have attached water outlets. Ultrasonic instrument tip must be cooled
by fluid to prevent overheating of the vibrating instrument tip. They are effective as
hand instruments in subgingival calculus removal, removal of attached and
unattached subgingival plaque, removal of toxins from root surfaces as well as in
reduction and maintenance of pocket depth. The water lavage from ultrasonic
instruments has three benefits on the treatment site.
• Flushing action–flushes calculus, blood, bacteria, plaque from treatment
site.

• Cavitation.
• Acoustic streaming.
As the water exits from the instrument tip, it forms a spray of tiny bubbles that
collapses and releases shock waves in a process known as cavitation. Disrupting
bacterial microflora.

Advantage of ultrasonic over hand Ins:

1 -Less effort, pressure, trauma and time.
2 -Simple manipulation.
3- Water sprays clean debris.
Disadvantage of sonic & ultrasonic instrumentations:
1 -Lack of tactile sensation because of light pressure during manipulation.
2 -Heat generation, requires a coolant system.
3 -Impair of visibility because of water spray.
4 -Aerosol contamination.
5 -Damage restorative materials (porcelain, amalgam, gold, composite and
titanium implant abutments(.
Contraindication of ultrasonic device:

1 -Infectious diseases .
 2-Cardiac pacemaker & hearing aids .
3 -Gag reflex
4 -young children
5- pain.
Plastic and Titanium Instruments for Implants:
Several different companies are manufacturing plastic and titanium instruments for
use on titanium and other implant abutment materials. Plastic or titanium
instruments must be used to avoid scarring and permanent damage to the implants
C. Cleansing and polishing instruments
Rubber cups, brushes, dental tapes
Rubber cups
Rubber cups consist of a rubber shell with or without webbed configurations in the
hollow interior. They are used in the handpiece with a special prophylaxis angle. The
handpiece, and prophylaxis angle must be sterilized after each patient use, or a
disposable plastic prophylaxis angle and rubber cup may be used and then discarded .
A good cleansing and polishing paste that contains fluoride should be used and kept
moist to minimize frictional heat as the cup revolves. Polishing pastes are available in
fine, medium, or coarse grits and are packaged in small ,convenient, single-use
containers. Aggressive use of the rubber cup with any abrasive may remove the layer
of cementum, which is thin in the cervical area.
Bristles brush
Bristle brushes are available in wheel and cup shapes. The brush is used in the
prophylaxis angle with a polishing paste. Because the bristles are stiff, the use of the
brush should be confined to the crown to avoid injuring the cementum and the gingiva.

Dental tape
Dental tape with polishing paste is used for polishing proximal surfaces that are
inaccessible to other polishing instruments. The tape is passed interproximally while
being kept at a right angle to the long axis of the tooth and is activated with a firm
labiolingual motion. Particular care is taken to avoid injury to the gingiva. The area
should be cleansed with warm water to remove all remnants of paste..
Air-Powder Polishing: The first specially designed handpiece to deliver an air-
powered slurry of warm water and sodium bicarbonate for polishing was introduced in
the early 1980s. This device, effectively removes extrinsic stains and soft deposits.
The slurry removes stains rapidly and efficiently by mechanical abrasion and provides
warm water for rinsing and lavage. The flow rate of the abrasive cleansing power can
be adjusted to increase the amount of powder for heavier stain removal. Polishing
powders containing glycine or erythritol rather than sodium bicarbonate are commonly
used for subgingival biofilm removal from root surfaces and implants. Both
supragingival and subgingival air polishing with glycine or erythritol powder are safe
and very effective for the removal of biofilm from titanium implant surfaces and
restorative materials. The use of glycine or erythritol powder in an air-polishing device
with a subgingival nozzle is more effective for subgingival biofilm removal than the
use of either manual or ultrasonic instruments.

D. surgical instruments
Excisional and incisional instruments, surgical curettes and periodontal elevators
scissors and nippers
Knives are basic instruments and can be obtained with both fixed and replaceable
blades.
 1. Kirkland knives are typically used for gingivectomy. These knives are kidney-
shaped and can be obtained as either double-ended or single-ended instruments.

2. Interdental knives eg: Orban knife These spear-shaped knives have cutting edges
on both sides and are designed with an either double-ended or single-ended blade.
useful for excising interproximal tissue.

3. Surgical blades eg:#12D,15,11.

Periodontal elevators These are needed to reflect and move the flap after the
incision has been made for flap surgery.
Tissues forceps: used to hold the flap during suturing and used to position and
displace the flap after reflection.

Scissors are used in periodontal surgery for such purposes as removing tags of tissue
during gingivectomy ,trimming the margins of flaps ,enlarging incisions in periodontal
abscesses, and removing muscle attachments in mucogingival surgery.
Surgical nippers: Serve same purpose as Scissors and they are also used for
contouring the architectural form and for forming interdental sluiceways

Needle holders: Used to suture the flap at the desired position after surgical procedure
has been complete.
Instrument Grasp : grasping can be divided into:
1. pen grasp: Index finger and thumb hold the instrument, middle finger under the
instrument. Usually provide less tactile sensitivity & flexibility of movement so
it is not recommended during periodontal instrumentation.

2. modified pen grasp : Index finger and thumb hold instrument. Middle finger
guides instrument, as it rest on the pad of middle finger so this will provide
tactile sensitivity. The ring-finger acts as fulcrum/finger rest while the little
finger relaxed beside ring [Link] it is recommended for all periodontal
instruments. This grasp allows precise control of the working end, permits a
wide range of movements and facilitates good tactile conduction.
 3. palm and thumb grasp: Fingers wrapped around handle, thumb used to stabilize
instrument. The palm and thumb grasp is useful for stabilizing instruments
during sharpening and for manipulating air and water syringes

Correct grasp provides:

• Maximized stability during instrumentation.
• Minimized patient trauma and operator fatigue.
• Improved tactile sensitivity.