This document discusses principles of periodontal instrumentation. It covers topics like accessibility, visibility, instrument condition, maintaining a clean field, instrument stabilization, and activation techniques. For accessibility, it discusses patient and operator positioning. For visibility, it discusses illumination, retraction, and use of mirrors. It emphasizes the importance of sharp, clean instruments and using suction and air to maintain a clear field. It describes different instrument grasps and finger rests for stabilization. Finally, it outlines techniques for instrument adaptation, angulation, pressure, and different stroke types like exploratory, scaling, and root planing.

1. DEPARTMENT OF PERIODONTOLOGY
PRINCIPLES OF INSTRUMENTATION

2. PRINCIPLES OF PERIODONTAL
INSTRUMENTS
• ACCESSIBILITY: POSITION OF PATIENT
&OPERATOR
• VISIBILITY, ILLUMINATION & RETRACTION.
 CONDITION & SHARPNESS OF INSTRUMENTS.
 MAINTAINING A CLEAN FIELD.
 INSTRUMENT STABILIZATION.
 INSTRUMENT ACTIVATION.

3. ACCESSIBILITY
 ACCESSIBILITY means to access
 ACCESSIBILITY FACILITATES THOROUGHNESS OF
INSTRUMENTATION.
 POSITION OF PATIENT & OPERATOR SHOULD
PROVIDE MAXIMAL ACCESSIBILITY.
 INADEQUATE ACCESSIBILITY IMPEDES THROUGH
INSTRUMENTATION , PREMATURELY TIRED THE
OPERATOR DIMNISHES EFFECTIVENESS OF
CLINICIAN.
 CLINICIAN SHOULD BE SEATED COMFORTABLY ON
A OPERATING STOOL , SO THAT CLINICIANS FEET
ARE ON THE FLOOR THE THIGHS PARALLEL TO THE
FLOOR.
 BE IN A STRAIGHT AND HEAD ERECT POSITION.

4.  Patient should be in supine position &placed so that
the mouth closed to the resting elbow of the clinician
 For instrumentation of maxillary arch patient chin
should be rise slightly
 For mandible arch, ask the patient to lower the chin
until the mandible is parallel to floor

6. VISIBILITY, ILLUMINATION AND
RETRACTION
 VISIBILTY means to see.
 ILLUMINATION means light
 RETRACTION means to retract
 DIRECT VISION WITH DIRECT ILLUMINATION FROM
DENTAL LIGHT.
 INDIRECT VISION BY USING MOUTH MIRROR.
 RETRACTION PROVIDES VISIBILITY, ACCESSIBILITY
AND ILLUMINATION.
 MIRROR ALSO USED FOR RETRACTION OF CHEEKS
AND TONGUE.
 INDEX FINGER IS USED FOR RETRACTION.

7.  WHEN RETRACTING , CARE SHOULD BE TAKEN TO
AVOID IRRITATION TO THE ANGLE OF MOUTH.
 CAREFUL RETRACTION IS ESPECIALLY IMPORTANT
FOR PATIENTS WITH THE HISTORY OF
RECURRENT HERPES LABIALIS, BECAUSE THESE
PATIENTS MAY EASILY DEVELOP HERPETIC
LESIONS AFTER INSTRUMENTATION.

10. CONDITIONINIG AND SHARPNESS
OF INSTRUMENT
 MAKE SURE THAT INSTRUMENTS ARE CLEAN , STERILE &
IN GOOD CONDITION.
 WORKING END OF THE POINTED OR BLADED
INSTRUMENT MUST BE SHARP TO BE EFFECTIVE.
 SHARP INSTRUMENTS ENHANCE TACTILE SENSTIVITY
& ALLOW THE CLINICIAN TO WORK MORE EFFICIENTLY.
 DULL INSTRUMENT MAY LEAD TO INCOMPLETE
CALCULUS REMOVAL AND UNNECESSARY TRAUMA
BECAUSE OF EXCESS FORCE USUALLY APPLIES TO
COMPENSATE FOR THEIR INEFFECTIVENESS.

12. MAINTAINING A CLEAN FIELD
 DESPITE GOOD VISIBILITY,ILLUMINATION AND
RETRACTION INSTRUMENTATION CAN Be HAMPERED IF
THE OPERATIVE FIELD IS OBSCURED BY SALIVA
,BLOOD&DEBRIS
 THE POOLING OF SALIVA INTERFERES WITH VISIBILITY
DURING INSTRUMENTATION &IMPEDES CONTROL
,BECAUSE A FIRM FINGER REST CANNOT Be
ESTABLISHED ON WET,SLIPPERY TOOTH SURFACE
 ADEQUATE SUCTION IS ESSENTIAL &CAN BE ACHIEVED
WITH SALIVA EJECTOR
 COMPRESSED AIR & GAUZE SQUARES CAN BE USED TO
FACILITATE VISUAL INSPECTION OF TOOTH SURFACES
JUST BELOW THE GINGIVAL MARGIN DURING
INSTRUMENTATION

13. INSTRUMENT STABILISATION
 INSTRUMENT GRASP
 MODIFIED PEN GRASP
 STANDARD PEN GRASP
 PALM AND THUMB GRASP
FINGER REST
 CONVENTIONAL
 CROSS ARCH
 OPPOSITE ARCH
 FINGER ON FINGER

14. INSTRUMENTATION GRASP
PEN GRASP
THE THUMB ,INDEX FINGER&MIDDLE FINGER ARE
USED TO HOLD INSTUMENT AS PEN IS HELD.

15. MODIFIED PEN GRASP:-
 THE MOST EFFECTIVE & STABLE GRASP
 THE PAD OF MIDDLE FINGER REST ON THE
SHANK

16. PALM AND THUMB GRASP:-
• USEFUL FOR STABILISING INSTRUMENTS DURING
SHARPENING & FOR MANIPULATING AIR & WATER
SYRINGE
 NOT RECOMMENDED FOR PERIODONTAL
INSTRUMENTATION

17. Palm and thumb grasp

18. FINGER REST
 SERVES TO STABILIZE THE HAND &THE
INSTRUMENT BY PROVIDING A FIRM FULCRUM AS
A MOVEMENTS
 A GOOD FINGER REST PREVENT INJURY
 MAXIMAL CONTROL IS ACHIEVED BY USING
MIDDLE FINGER
 MIDDLE FINGER IS KEPT BETWEEN THE
INSTRUMENT SHANK AND FOURTH FINGER

19. FINGER REST
INTRAORAL FINGER RESTS EXTRA ORAL FALCRUMS
1) CONVENTIONAL
2) CROSS ARCH
3) OPPOSITE ARCH
4) FINGER ON FINGER
1)PALM UP
2) PALM DOWN

20. INTRA ORAL FINGER REST
ITS ON TOOTH SURFACE CLOSE TO THE
WORKING AREA
1)CONVENTIONAL:- THE FINGER REST IS
ESTABLISHED ON TOOTH SURFACES IMMEDIATELY
ADJACENT TO THE WORKING AREA.

21. 2) CROSS-ARCH:- THE FINGER REST IS ESTABLISHED
ON TOOTH SURFACES ON THE OTHER SIDE OF
SAME ARCH.

22. 3) OPPOSITE ARCH:- THE FINGER REST IS
ESTABLISHED ON TOOTH SURFACES ON THE
OPPOSITE ARCH.

23. 4) FINGER ON FINGER:- THE FINGER REST IS
ESTABLISHED ON THE INDEX FINGER OR THUMB
OF THE NON OPERATING HAND.

24. EXTRA ORAL FULCRUMS:-
 EFFECTIVE FOR POSTERIOR MAXILLARY TOOTH
 ALLOW OPTIMAL ACCESS &ANGULATION WHILE
PROVIDING ADEQUATE STABILISATION
 FINGERS IS PLACED ON THE PATINT’S FACE TO
PROVIDE GREATEST DEGREE OF STABILITY.

25. 2 TYPES
1) PALM UP :- THE PALM FULCRUM IS ESTABLISHED
BY RESTING THE BACKS OF THE MIDDLE FINGER
&FOURTH FINGER ON THE SKIN OVERLYING THE
LATERAL ASPECT OF MANDIBLE ON THE RIGHT
SIDE OF THE FACE.

26. 2) PALM –DOWN:- THE PALM DOWN FULCRUM IS
ESTABLISHED BY RESTING THE FRONT SURFACES OF
THE MIDDLE & FOURTH FINGER ON SKIN
OVERLYING THE LATERAL ASPECT OF THE
MANDIBLE ON THE LEFT SIDE OF FACE.

27. INSTRUMENT ACTIVATION
1) ADAPTATION
 ADAPTATION REFERS TO THE MANNER IN WHICH
THE WORKING END OF PERIODONTAL
INSTRUMENT IS PLACED AGAINST THE SURFACE
OF TOOTH
 OBJECTIVE IS TO MAKE THE WORKING END OF
INSTRUMENT CONFORM TO THE CONTOUR OF
THE TOOTH SURFACE

29. 2) ANGULATION:-
 IT REFERS TO THE ANGLE BETWEEN FACE OF A
BLADED INSTRUMENT AND THE TOOTH SURFACE
 ALSO CALLED TOOTH –BLADE RELATIONSHIP
 DURING INSERTION ANGLE IS-0
 SCALING &ROOT PLANING -45-90

30. 3) LATERAL PRESSURE
 IT REFERS TO THE PRESSURE CREATED WHEN
FORCE IS APPLIED AGAINST THE SURFACE OF
TOOTH WITH THE CUTTING EDGE OF A BLADED
INSTRUMENT
 MAY Be FIRM, MODERATE OR LIGHT
 UNCONTROLLED APPLICATION OF HEAVY
FORCES SHOULD BE AVOIDED

31. 4) STROKES
3 TYPES
EXPLORATORY STROKE
SCALING STROKE
ROOT PLANING
ANY OF THESE STROKES MAY BE ACTIVATED BY A
PULL OR PUSH MOTION IN VERTICAL ,OBLIQUE
OR HORIZONTAL DIRECTION

33. EXPLORATORY STROKE
 LIGHT FEELING STROKE USED WITH PROBES &
EXPLORES TO EVALUATE THE DIMENTION OF
POCKET & TO DETECT CALCULUS&
IRREGULARITIES ON TOOTH SURFACE

34. SCALING STROKE
 SHORT POWERFUL PULL STROKE USED WITH
BLADED INSTRUMENTS FOR THE REMOVAL OF
BOTH SUBGINGIVAL & SUPRAGINGIVAL CALCULUS
.
 SCALING MOTION SHOULD BE INITIATED IN THE
FORCE ARM &TRANSMITTED TO THE WRIST TO
THE HAND WITH A SLIGHT FLEXION OF FINGERS
 PUSH SCALING MOTION IS RARELY USED

35. ROOT PLANING STROKE
 MODERATE TO LIGHT PULL STROKE USED FOR
FINAL SMOOTHENING &PLANING OF THE
ROOT SURFACE
 HOES, FILES, CURETTES & ULTRA SONIC
INSTRUMENTS CAN BE USED