CUTTING INSTRUMENTS

PRESENTED BY:
PAYAL GUPTA (64) 3rd prof.

CUTTING INSTRUMENTS:
instrument(s) : a tool or implement, especially one used for
delicate or scientific work.(e.g., knife).

Cutting Instrument : an instrument used to cut, cleave, or

plane the walls of a cavity preparation; the blade ends in a sharp, beveled edge.

Materials used in the manufacture of hand instruments:

Carbon steel : alloy made by addition of small percentage of carbon (0.51.5%) to iron. Other ingredients, Mn (0.2%), Si (0.2%), rest is Fe (98.4-98.6%) Melting point: 1500-1600 degree C.

Stainless steel: it is composed of Carbon(6-10%), Cr (18%) and Fe(81-81.4%)

Heat treatments of steel :

There are two methods,

Hardening heat treatment : steel is heated to 1500 degree F (815 degree C) in oxygen free enviornment, then quenched in oil. It makes alloy harder but also makes steel brittle.

Tempering heat treatment :

steel is reheated for one hour at 350 degree F(176 degree C) and then quenched in oil. This relieves the strain and increases the toughness.

Methods of sterilization:

Sporicidal cold disinfection Boiling Steam under pressure( autoclave) Chemical vapor Hot air (dry heat)

Methods to prevent discoloration, rust and corrosion caused by sterilization:

Electroplate the instruments ( used by manufacturers) Use of rust inhibitors (soluble alkaline compounds) remove the instruments promptly at the end of the recommended sterilizing period, dry them thoroughly BLACK is credited with the first acceptable nomenclature for and classification of hand instruments.

CLASSIFICATION:
Cutting:
1. Excavator Ordinary hatchets Hoes Angle formers spoons 2. Chisels Straight chisels Curved chisels Binangle chisels Enamel hachets Gingival marginal trimmers 1. 2. 3. 4. 1. 2. 3. 4. Amalgam condensers Mirrors Explorers probes Knives Files Sclares carvers

Non cutting :

Others:

INSTRUMENT DESIGN:
Most hand instruments are compsed of three parts: 1. Handle 2. Shank 3. blade

BLADE: The blades are of many shapes and sizes depending on the function they are to perform.

DOUBLE-ENDED INSTRUMENT

SINGLE-ENDED INSTRUMENT

Some instruments have a blade on both ends of the handle and are known as double ended instruments. When instrument blade is on one side only so known as single ended instrument.

Handle: Early hand instruments had handles of quite large diameter It is not always conductive to delicate manipulation. Now handles with small diameter (5.5mm) and which are light are used. They are commonly eight sided and knurled to facilitate control.

Shanks: it serve to connect the handle to the working ends of the instruments. They are normally smooth, round and tapered. They often have one or more bends to avoid instrument having a tendency to twist in use when force is applied.

INSTRUMENT SHANK ANGLES:

Black classification based on number of shank angles as: 1. Mon-angle (one) 2. Bin-angle (two) 3. Triple-angle (three) Instruments with short blades may be easily designed in mon-angle form. And with longer blades or more complex orientations may require two or three angles in shank to bring the cutting edge near to long axis of the handle.

INSTRUMENT NAMES:

Blacks classification system by instrument name categorised instruments by: 1. Function (e.g., scaler, excavator) 2. Manner of use (e.g., hand condenser) 3. Design of working end (e.g., spoon excavator, sickle scaler) 4. Shape of the shank (e.g., mon-angle, bin-angle, contra-angle.
These names were combined to form the complete description of the instrument (e.g., bin-angle spoon excavator)

OPERATIVE CUTTING INSTRUMENT FORMULAS:

Describes the dimensions and angle of the working end. Placed on the handle using a code of three or four numbers separated by dashes. (e.g., 10-8.5-8-14). First number indicates the width of the blade or primary cutting edge in tenths of a millimeter (0.1 mm) (e.g., 10=1mm). Second number indicates the primary cutting angle, measured from a line parallel to the long axis of the instrument handle in clockwise centigrades. The angle is expressed as a percent of 360 degrees (e.g., 85=85% x 360degree = 306 degrees). Instrument is positioned so that this number always exceeds 50.

Third number indicates blade length in millimeters (e.g., 8=8mm). Fourth number indicates the blade angle, relative to the long axis of the handle in clockwise centigrade (e.g., 14=50 degrees).

CUTTING INSTRUMENT BEVELS:

Single bevelled instruments: instruments which have a bevel on only one side. Distally bevelled: if the bevel is on the side away from the shaft. Mesially bevelled: if the bevel is on the side towads the shaft. Right sided instruments: if the bevel is on the right side of the instrument blade. Left sided instruments: if the bevel is on the left side of the instrument blade. Bibevelled instruments: which have two bevels on the opposite side of the blade which meet to form cutting edge. Triple-bevelled instruments: bevelling the blade laterally, together with the end, forms three distinct cutting edges. Circumferentially bevelled instruments: these are usually double-planed instruments where the blade is bevelled at all peripheries (e.g., spoon excavator).

HAND CUTTING INSTRUMENTS:

1. CHISELS: these are intended for planning and cleaving. characterised by a blade that terminates in cutting edge formed by onesided bevel. Cutting edge is at right angle to the shaft. TYPES: a. Straight chisel: straight blade in line with the handle and shank. cutting edge is on one side. b. Monangle chisel: blade is placed at an angle to the shaft. may be mesially or distally bevelled. c. Binangle chisel: have two angles between the shaft and blade. May be mesially or distally bevelled. d. Triple-angle chisels: have three angles in the shank and used to flatten the pulpal floor. May be mesially or distally bevelled.

Shank and the blade of chisel is slightly curved (Wedelstaedt design).

CHISELS

2. EXCAVATORS: used for excavation and removal of caries and sharpening or refinement of internal parts of cavity preparation.

TYPES:

a. Hatchet: has cutting edge of the blade directed in the same plane as that of long axis of handle and is bibeveled. b. Hoe excavator: primary cutting edge of the blade perpendicular to the axis of the handle. c. Spoon excavator: used for removing caries and carving amalgam or direct wax patterns. Discoid excavator: have circular edge. Cleoid excavator: blade resembles the claw. 3. OTHERS: a. KNIVES: nibs of these carry knife-edged faces on one of their sides only. a. FILES: nibs in files can be foot shaped, hatchet shaped or paralleogram shaped with serrations.

HAND INSTRUMENT TECHNIQUES:

There are four grasps used with hand instruments: 1. Modified pen 2. Inverted pen 3. Palm-and thumb 4. Modified palm-and thumb

Modified Pen: similar to that used in holding a pen.

Pads of the thumb, index and middle fingers contact the instrument Tip of the ring finger (or little finger) is placed on nearby tooth surface on the same arc as a rest. Palm of the hand is facing away from the operator. Pad of the middle finger is placed near the topside of the instrument. This finger working with wrist and forearm generates pressure on the blade for cutting and cleaving. This position appears comfortable as it limits the application of pressure. Finger positions are same. Hand is rotated, so that the palm faces more towards the operator. Used mostly for tooth preparations employing the lingual approach on anterior teeth.

Inverted Pen Grasp:

Palm-and-Thumb Grasp: similar to that used for holding a knife

while paring the skin from an apple. Handle is placed in the palm of the hand and grasped by all the fingers. 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.

Modified Palm-and-Thumb Grasp: used when it is feasible to rest

the thumb on the tooth being prepared or the adjacent tooth. Handle is held by all four fingers. Pads press the handle against the distal area of the palm and the pad and first joint of the thumb. This grip fosters control against slippage. RESTS: a firm rest to steady the hand during operating procedures, rest is established by placing the ring (or little) finger on the tooth (ot teeth) of the same arch and as close to the operating site as possible. Closer the rest , more reliable it is. GUARDS: are the hand instruments or other items, used to protect soft tissues from contact with sharp cutting or abrasive instruments. Such as interproximal wedges.

SHARPENING OF HAND INSTRUMENTS:

Instruments with dull cutting edges :Causes more pain Prolong operating time More difficult to control reduce quality and precision in tooth preparation. So all cutting instruments should be sharp. Resharpening requires little time.

PRINCIPLES OF SHARPENING:

1. Sharpen instruments only after they have been cleaned and sterilized. 2. Establish the proper bevel angle (usually 45 degrees) and desired angle of the cutting edge to the blade before placing the instrument against the stone, and maintain these angles while sharpening. 3. Use a light stroke or pressure against the stone to minimize frictional heat. 4. Use a rest or guide whenever possible. 5. Remove as little metal from the blade as possible. 6. Lightly hone the unbeveled side of the blade after sharpening, to remove the fine bur that may be created. 7. After sharpening, resterlize the instruments along with other items on the instrument tray setup. 8. Keep the sharpening stones clean and free of metal cuttings.

EQUIPMENTS USED FOR SHARPENING:

1. Stationary Shapening Stones 2. Mechanical Sharpeners 3. Handpiece Sharpening Stones

Stationary Sharpening Stones:

Most frequently used. Consists of a block or stick of abrasive material called a stone. Stone is supported on a firm surface, n instrument is oriented and held by hand while being stroke against the stone surface. Stationary stones are often are often called oilstones. Application of a coating of oil to aid in sharpening process. Available in coarse, medium, or fine grit. Fine grit for final sharpening. Obtained in various shapes, including flat, grooved, cylindrical, and tapered. Flat stones are preferred for instruments with straight cutting edges. Other shapes are used for curved cutting edge. Four types of materials are in common use: a. Arkansas stone. b. Silicon carbide (SiC). c. Aluminum oxide. d. Diamond.

MECHANICAL SHARPENERS: E.g. : The Rx Honing Machine (Rx Honing Machine corp, Mishawaka, IN). This instrument moves a hone in a reciprocating motion at a slow speed Instrument is held at the appropriate angulation and supported by a rest. HANDPIECE SHARPENING STONES: Mounted SiC and aluminum oxide stones for use with straight and angle handpieces. Available in various sizes and shapes. Speed is variable. Lacks rest or guide for the instrument.

SHARPENING TECHNIQUES:
MECHANICAL SHARPENING TECHIQUE: While using reciprocating honing sharpener (mechanical sharpeners) the blade should be placed against the steady rest and the proper angle of the cutting edge to the blade should be established before activating the motor. Used for instruments like: chisels, hatchets, hoes, angle former, or gingival margin trimmers.

STATIONARY STONE SHARPENING TECHIQUES: Size of Arkansas oilstone should be at least 2 inches wide and 5 inches long. Before using, a thin film of light oil should be placed on the working surface. Stone should be laid on a flat surface and should not tilt while sharpening. Instrument should be grasped with a pen grip, to avoid rotation or change in angles while sharpening. Third and fourth fingers are used as rest and guide along a flat surface to prevent rolling of instrument and to ensure stability.

SHARPNESS TEST:

sharpness of a instrument can be tested : By lightly resting the cutting edge on a hard plastic surface. If cutting edge digs in during an attempt to slide the instrument forward over the surface, the instrument is sharp. If it slides, the instrument is dull. Very light pressure is exerted in testing for sharpness.

POWERED CUTTING EQUIPMENT:

ROTARY CUTTING INSTRUMENT: it refers to a group of instruments that turn on an axis to perform a work such as cutting, abrading, burnishing, finishing or polishing tooth tissues or a restoration.

HANDPIECE: Its a device for holding rotating instruments, transmitting power to them, and for positioning them intraorally. Dental handpiece are classified according to the driving mechanism: Gear Driven Handpiece Water Driven Handpiece Belt Driven Handpiece Air Driven Handpiece

HANDPIECE

ROTARY SPEED RANGES:

Measured in revolutions per minute (rpm). Three speed ranges are: Low or slow speeds (<12,000 rpm) Medium or intermediate speeds ( 12,000-200,000 rpm) High or ultrahigh speeds (>200,000 rpm) Most useful instruments are rotated at either low or high speed. Low Speed Range is used for: Cleaning teeth Occasional caries excavation Finishing and polishing procedures High Speed Range is used for: Tooth preparation Removing old restoration

COMMON DESIGN CHARACTERISTICS:

1. Shank 2. Neck 3. Head

Shank : shank is the part that fits into the handpiece, attempts the rotary motion from the handpiece, and provides a bearing surface to control the alignment and concentricity ot the instrument. Its design and dimensions vary with the handpiece for which is intended. ADA Specification No. 23 for dental excavating burs includes five classes of instrument shank. Three of these are: The straight handpiece shank The latch-type angle handpiece shank Friction-grip angle handpiece shank Neck: the neck is the intermediate part of the instrument that connects the shank to the head. It tapers from the shank diameter to a smaller size adjacent to the head Size should be adjusted that it allows greatest possible visibility and manipulation. Function: to transmit rotational and translational forces to the head.

Head: is the working part of the instrument whose cutting edges perform the desired shaping of the tooth structure. Shows great variation in design and construction, size and shape. Based on head characteristics, the inatrument can be bladed or abrasive. DENTAL BURS: Term bur is applied to all rotary cutting instruments that have bladed cutting heads. Includes instruments intended for: Finishing metal restorations Surgical removal of bone Tooth preparation

DENTAL BURS

HISTORICAL DEVELOPMENT OF DENTAL BURS:

Earliest burs were hand made and they were expensive and variable in dimensions and performance. Machine-made were introduced in 1891. Early burs were made of steel. Steel burs: perform well, cutting human dentin at low speeds, but dull rapidly at higher speeds or when cutting enamel. Creates increased heat and vibration. Carbide burs: were introduced in 1947. These are harder than steel burs. Less subject to dulling during cutting. these have heads of cemented carbide in which microscopic carbide particles, usually tungsten carbide, are held together in a matrix of cobalt or nickel.

EARLY STEEL BURS

BUR CLASSIFICATION SYSTEM: According to : Shapes sizes SHAPES: Bur shape refers to the contour of the head. Basic head shapes are: Round Inverted cone Pear Straight fissure Tapered fissure Round Bur: It is spherical. Used for initial entry into the tooth, extension of the preparation, preparation of retention features and caries removal. Inverted Cone Bur: Portion of a rapidly tapered cone with apex of the cone directed towards the bur shank. Used for providing undercuts in tooth preparation.

Pear-shaped Bur: Portion of a slightly tapered cone with the small end of cone directed towards the bur shank. Used in class I tooth preparation. Long-length pear bur is advocated for tooth preparations for amalgam. Straight Fissure Bur: Is an elongated bur. It is advocated for amalgam tooth preparation. Tapered Fissure Bur: Portion of a slightly tapered cone with the small end of the cone directed away from the bur shank. Used for tooth preparations for indirect restorations. SIZES: numbering system was developed by SS White Dental Manufacturing Company in 1891. Burs were grouped by 9 shapes and 11 sizes. The and were added with the introduction of small sized instruments. Crosscut burs were indicated by adding 500 to the equivalent non crosscut size, e.g., no. 56 bur with crosscuts was designated as 556. End cutting bur was indicated by adding 900 to the equivalent size.

MODIFICATIONS IN BUR DESIGN: Modifications were seen because of introduction of high speed hand pieces. 3 major changes included : Reduced use of crosscuts Extended heads on fissure burs Roundening of the sharp tip angles Crosscuts are notches present on the blade of the instrument to obtain

adequate cutting effectiveness at low speeds.

These tend to produce unduly rough surfaces at high speeds. So crosscut

burs designed to be used at low speeds have now been replaced by equivalent non crosscuts burs to be used at high speeds.

Extended head lengths, two to three times the normal length of similar

diameter, as such design is not practical at low speeds using a brittle material such as carbide.

Roundening of sharp angles enhances the strength of the tooth and also the

instrument lasts longer because there are no sharp corners to chip and wear.

DESIGN OF A DENTAL BUR: Cutting action of a bur takes place at the edge of the blade present on the bur head. Head consists of uniformly spaced blades with depressed areas in between them known as flute or the chip spaces. Blades are usually 6 to 8 to 10. On finishing bur are usually 12 to 40. Greater the no. of blades, smoother is the cutting action at low speeds. Only one blade cuts effectively at one time at high speeds.

BLADE: Its Projection on the bur head. Terminates in the cutting edge. It has two surfaces: The blade face/rake face(towards the direction of cutting i.e. the surface of bur blade on the leading edge). The blade back/flank/clearance face(is the surface of bur blade on the trailing edge).
Three important angles: The rake angle The edge angle Clearance angle

Rake Angle: it is the angle between the rake face and the radial line ( line connecting the centre of the bur and the blade). It is the most important design characteristic of a bur blade. It can be positive, negative or a zero rake angle. It is negative when the rake face is ahead of the radial line. It is positive when the rake face trails the radial line. It is zero or the radial rake angle, seen when the rake face and radial line coincide with each other. Land: the plane surface immediately following the cutting edge. Clearance Angle: it is the angle between the clearance face and the work.
if land is present on the bur, the clearance angle is divided into two: Primary clearance angle (i.e. angle between the land and the work) Secondary clearance angle (i.e. the angle between the clearance face and the work) Radial clearance: If the clearance face is curved.

Blade angle/tooth angle: angle between the rake face and the clearance face.
If land is present, it is the angle between the rake face and the land.

ABRASIVE INSTRUMENTS: These are based on small, angular particles of a hard substance held in a matrix of softer material called as binder. Materials used for a binder are: Ceramic Metal Rubber Shellac Abrasive instruments are grouped in Diamond abrasive instruments Other abrasives Diamond instruments have clinical impact because of their long life and great effectiveness in cutting enamel and dentin. Other abrasives instruments includes use of: Silicon carbide Boron carbide Aluminum oxide Garnet Sand These are used for producing grinding wheels, discs or stones etc.

DIAMOND ABRASIVE INSTRUMENTS: Introduced in United States in 1942. It consists of three parts: A metal blank Powered diamond abrasive A metallic bonding material Metal blank : it resembles a bur without blades. It has same parts: head, neck and shank. Head of the blank is slightly smaller then the final dimensions of the instrument head. Neck is normally a tapered section of reduced diameter that connects the shank to the head. Shank is similar to that of a bur. Abrasive Diamond: May be natural or synthetic. These are crushed to a powder of desired particles, in size and shape. Manufactured in multiple layers by electrodeposition, sintering or microbrazing. Provides a continous regeneration of the cutting surface as wear occurs.

Bonding Agent: Serves purpose of holding the abrasive particles together as well as attaches the particles to the metal blank. Ceramic and metals are the most commonly used bonding agents. CLASSIFICATION: On the basis of the average particle sizes: Coarse grit diamond burs (125-150 um particle size) Medium grit diamond burs (88-125 um particle size) Fine grit diamond burs (60-74 um particle size) Very fine diamond burs (38-44um particle size)

Diamond instruments are available in a wide variety of shape and sizes.

DIAMOND PARTICLE FACTORS: The clinical performance of diamond abrasive instrument depends on: Size, Shape, Uniformity, Exposure and Bonding of the diamond particles.

OTHER ABRASIVE INSTRUMENTS:

They are divided in two distinct groups: Molded instruments Coated instruments

Molded abrasive instruments:

they have heads that are manufactured by molding or pressing a uniform mixture of abrasive and matrix around the roughened end of the shank or cementing a premolded head to the shank. They have much softer matrix and wear during use. Abrasive is distributed throughout the matrix so that new particles are exposed by the wear. Mounted heads are termed points and stones.

Coated abrasive instruments: are mostly discs that have a thin layer of

abrasive cemented to a flexible backing. This type of construction allows the instrument to conform to the surface contour of a tooth or restoration. May be used in finishing and smoothening procedures of certain enamel walls (and margins) of tooth preparation.

CUTTING TECHIQUES:
Cutting can be measured in terms of effectiveness. Cutting Effectiveness: is the rate tooth structure removal in mm/min or mg/s. Does not consider potential side effects, such as heat or noise.

Cutting efficiency: is the percentage of energy actually producing cutting.

Efficiency is reduced when energy is wasted as heat or noise. Increase in rotary speed causes: Heat Vibration Noise Heat causes pulpal injury. Rotary instruments can cut by two mechanisms: Bladed cutting Abrasive cutting

Bladed Cutting: It refers to the use of bladed instrument or the use of any instrument in a blade like fashion. Blade must be sharp. Should have higher hardness and modulus of elasticity than the material being cut. The sheared segment form a distorted layer. This move up the rake face until it breaks of until the blade disengages from the surface as it rotates. These chips accumulate in the clearance space between the flutes until they are washed away or removed by centrifugal force.
Abrasive Cutting: or grinding Refers to the use of bonded or coated abrasive instruments for removing small particles of the substrate. These instruments contain randomly arranged abrasive particles that are very sharp. They have large negative rake angles.