seminar on hand instruments

2. OPERATIVE HAND
INSTRUMENTS
Presented by
DR SNEHA RATNANI

3. Contents
• Introduction, history & classification
• Parts of a hand cutting instrument
• Instrument nomenclature
• Instrument formula
• Instrument design
• Instrument applications
• Techniques
• Rests and guards
• Sharpening hand instruments
• Sterilization and disinfection
• Conclusion
• References

5. I
INTRODUCTION
 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.
Theinstruments available
Thepurposeof the instrument
Theposition or manner of use
Theapplication ofthe instrument.

6. DEFINITION
 .
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 generally required to perform specific procedures.
-2nd edition M.A. Marzouk

7. HISTORY

8. HISTORY
EARLY HAND OPERATED INSTRUMENTS
large, heavy handles and inferior metal alloys , ivory or animal
horns or bones
Drawbacks :
 cumbersome, awkward to use, ineffective
 no uniformity of manufacture or nomenclature
 effective sterilization was a problem

9. .
 G.V. Black is credited with the first
acceptable nomenclature and classification
of hand instruments.
 His classification system enabled both
dentists and manufacturers to communicate
more clearly and effectively in regard to
instrument design and function.
G.V. Black

10. . Dr.Arthur.D.Black- developed many of the instruments and techniques
 • Dr.Charles E.Woodbury- first to modify black’s instrumentation.
Designed 39 sets of hand instruments for class III cavity preparations
and condensing points for 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

11. MATERIALS
 Hand cutting instruments are manufactured from two main materials
:Carbon steel and Stainless steel
Stainless Steel carbon steel
 Tungsten carbide, although hard and wear resistant, is brittle and
cannot be used in all designs.

12. Stainless steel
Chromium- 18%
Carbon-1%
Iron-81.4%
Adv-
Chromium in the alloy
reduces tarnish and corrosion
tendency by depositing an
oxide layer on the surface of
the metal.
Remains bright under
most conditions.
Disadv-
Maintaining the sharpness
of the blade is a problem
Loses a keen edge during
much use.
Carbon steel
Carbon-1%
Manganeese-0.2%
Silicon-0.2%
Iron- 98.4-98.6%
Adv-
Harder and sharper than
stainless steel
Disadv-
When unprotected, it will
corode and fracture if
instrument is dropped.
Stellite
Cobalt - 65- 90%
Chromium - 35%
Trace amounts tungsten,
molybdenum, Iron.
Adv-
High resistance
to acid
Hardness
Use-
Manufacture of
mixing and
inserting
instruments

13. 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)

14. HEAT TREATMENT
HARDENING TREATMENT
• The steel is heated to
1500-16000 F (815degree C) in
oxygen free enviornment and
then quenched in a solution of oil.
• Not more than 1-2mm of
the tip is heated for
hardening purpose,
otherwise the instrument
will lose its balance after
Sharpening
• Hardens the alloy, but it
also makes it brittle,
TEMPERING TREATMENT
Quenched in solutions of
oil, acid or mercury at
176 degree c for 10 min.
Tempering is done to relieve strain
and increase toughness of the
alloy
To accomplish this, the
tip is reheated at a lower
Temperature

15. Heat
treatment
Furnace

16.  G.V.BLACK- first acceptable nomenclature for
and classification of hand instruments
CUTTING NON-CUTTING
a. Excavators
- ordinary hatchet
- hoes
- angle formers
- spoons
b. Chisels
- straight
- curved
- bin angle
- enamel hatchet
- GMT
c. Other cutting
insruments
- Knives, carvers
- files, scalers
-Amalgam
condensors
- Mirrors
- Explorers
- Probes

17. CLASSIFICATION
I) According to Charbenaeu:
Operative instruments can be conveniently classified
into 6 categories.

18. .1) Cutting instruments
a) Hand
 Hatchets
 Chisels
 Excavators
 Others
b) Rotary
 Stones
 Burs
 Disks
 Others
2)Condensing instruments
Pluggers : Hand
 Mechanical
3)Plastic instruments
Spatulas
Carvers
Burnishers
Packing instruments
4)Finishing and polishing
instruments
a)Hand : Orange wood sticks
 Polishing points
 Finishing strips
b)Rotary
 Finishing burs
 Mounted brushes
 Mounted stones
 Rubber cups
 Impregnated disks and
wheels
5)Isolation instruments
 Rubber dam frame
 Clamps, forceps, punch
 Saliva ejector
 Cotton roll holder
 Evacuating tips and
equipment
6)Miscellaneous instruments
 Mouth mirrors
 Explorers
 Probes
 Scissors, pliers and others

19. CLASSIFICATION
II) According to Marzouk:
Instruments for operative dentistry procedures can be generally
classified as
1) Those used for exploration
2) Those used for removal of tooth structure.
3) Those used for restoration of teeth.

20. ACC TO MARZOUK
1)Those used for exploration
A) Dry the area on the teeth: This necessitates the use of an
● Air syringe.
● Pair of tweezers (pliers)
● Cotton pellets to dry the tooth.
● Cotton rolls – to isolate the area around the tooth.

21. B) Illuminate the area: A source of light could be either an overhead fixture supplying
non-reflecting light or an intra-canal light. They can be
– Battery operated lights.
– Built in lights attached to dental unit.
– Light attached to mirror or hand piece.
Light can be introduced directly or indirectly by reflecting via a mirror.

22. C) To retract the soft tissues: The mouth mirror is used to move the tongue and
cheek away.
– Blunt plastic instruments may help in retraction.
– Tongue depressor or retractors are also helpful for this procedure.
D) To probe the potential lesion : Explorers are used for this purpose.
These are 4 types of explorers.
Straight explorer.
Right angled explorer
Arch explorer
Inter-proximal explorer.
E)Separartors

24. ACC TO MARZOUK
2) Those used for tooth structure removal:
 Hand cutting instruments.
 Rotary cutting and abrasive instruments.
 Ultrasonic instruments
3) Those used for restoring:
 Mixing instruments
 Spatulas
 Plastic instruments
 Condensing instruments
 Burnishing instruments
 Carvers
 Files
 Knives
 Finishing and polishing instruments.

25. NOMENCLATURE
G.V. Black prescribed four classes similar to biological
classification
Order - purpose of the instrument.
Sub order - position or manner of use
Class - form of the blade.
Subclass - shape of the shank
NAMING GOES FROM 4-1
Bin angle hatchet push excavator

26. PARTS OF HAND CUTTING INSTRUMENTS
 blade with cutting edge or nib with face(a)
 shank (b)
 Handle / shaft (c)

27. HANDLE / SHAFT
 Length-5.5 inches
 Diameter-5.5 mm
 Available in various sizes and shapes- small, medium, large diameter
 Cross-section
Hexagonal octagonal
 Handle designs
Smooth serrated knurled
for better grasping and developing
pressure

28. .
 Instrument formula incorporated on it
 Manufacturing kit number incorporated on it
 Handle is either continuous with shank or seperable

29. SHANK
 Connects the shaft with the blade or working point 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
 G.V.Black classified instruments depending on the number of
angles in the shank as-

30.  a
Instruments classified by number of angles in the shank
a) straight, b) monoangled , c) biangled , d) tripleangled e) quadrangled

31. CONTRANGLING & BALANCE
 CONTRANGLE refers to shank in which two or
more angles are necessary to bring working end
into near alignment with( within 2 to 3mm ) the axis
of handle.

32. Advantages
 Prevent rotation
 Modified access
 Greater stability and balance
 Ease of control
Working end should be
within 2-3mm

33. BLADE
 Blade- is the part of the instrument
bearing the cutting edge.
 Connected to handle by shank.
 Non cutting instruments- part
corresponding to blade- is called
NIB, end of the nib or working
surface is called FACE

34. CUTTING EDGE
 Cutting edge- is the working
part of the instrument.
 It is usually in the form of a
bevel in different shapes.
 Beveled-
- single beveled
- Bibeveled
- Triple beveled
-Circumferentially beveled
 • Regular bevel-
- distal to shaft
 • Reverse bevel-
- mesial to shaft eg:- binangle
chisel
Single bevelled bibevelled circumferentially
bevelled

35. .
DIRECT CUTTING
1)Force is applied in the same
plane as that of the blade and
handle.
2)Straight blade.
3)All the angles and curves in the
shank are in same plane as the
handle.
4)Used in direct and lateral cutting.
LATERAL CUTTING
1)Force is applied at a right angle
to the plane of the blade and
handle.
2)Curved blade.
3)Angles or curves in a plane at
right angle to the handle.
4)Can only be used in lateral
cutting (scraping action).

36. INSTRUMENT FORMULA GIVEN BY G. V .BLACK
FOR HAND CUTTING INSTRUMENTS
3 unit instrument formula.
 Cutting edge of the instrument is at
right angle to the blade
 1. First unit Width of the blade in
1/10th of a mm.
 2.Second unit Length of the
blade in millimeter.
 3. Third unit Angle the blade
forms with the axis of the handle in
centigrade.
Instrument formula for enamel hatchet

37. 4 UNIT INSTRUMENT
FORMULA
 Cutting edge of the instrument is at
an angle other than right angle to
the blade
 1. First unit Width of the blade in
1/10th of a mm.
 2.Second unit angle the cutting
edge forms with the axis of the
handle in centigrade is primary
cutting edge angle.
 3. Third unit Length of the blade in
millimeter.
 4.fourth unit Angle the blade
forms with the axis of the handle in
centigrade.

38. FOUR NO. FORMULA( GINGIVAL MARGINAL
TRIMMER)
 13 – Blade width
1.3 mm
 95 – Primary
cutting edge
angle in
centigrade
 8 - Blade
length 8mm
 14 - Blade angle

39. MEASURING GAUGES

41. TYPES OF HAND CUTTING INSTRUMENT
Chisels
 Cutting edge of the instrument is at right angle to the axis of
the handle of instrument
 Used for planing or cleaving enamel
1. Straight chisel
 No bend in the shank
 Mono bevelled/triple bevelled
 Minimal accessibility
 Used with push stroke or
lateral cutting action

42. .
Monoangle chisel :
-If the angle of the blade is less than 12.5
degree centigrade it is monoangle chisel.
-Blade is shorter as compared to chisel
- Single angle in the shank
-Used with push stroke or lateral cutting
action
Hoe
If the angle of the blade is more than 12.5
degree centigrade it is hoe
Used with pull stroke
Use : to define line and point angles in
Class III and V preparations for direct filling
gold .

43. .
3) Binangle chisel
 Two angles in shank
 Used to cleave or split undermined enamel
 Reverse bevel instrument
 Ring on the shank of chisel - Reverse bevel instrument.
 Ring on the shank of hatchet – Right side instrument.
4) Triple angle chisel
 Used to flatten the pulpal floor
 Three angles in the shank .
 May be mesially or distally bevelled.

44. .
Ordinary Hatchet, bibevelled, hatchet
excavator
1)Cutting edge is parallel to axis of the
instrument.
2)Cutting edge at right angle to axis of blade
3)Monoangled
4)Length of the blade is very small.
5)Bibevelled
6)Used with push stroke.
7)Uses : To prepare retentive areas in anterior
teeth
8)Sharpening internal line angles in direct filing
gold preparations.

45. ENAMEL HATCHET
 Blade larger, heavier and beveled on only one
side, rather than the ordinary hatchet
 Cutting edge in a plane parallel with the axis of
the handle
 Used for cutting enamel in proximal cavities
and comes as right or left types for use on
opposite sides of the preparation

46. .
 Used for smoothening buccal and lingual walls of
proximal box.
 Used for breaking unsupported enamel of
proximal box.
 Used for smoothening gingival seat (lateral
scraping motion).

47. .
3 Gingival marginal trimmer -
modified enamel hatchet
• Blade curved and primary
cutting edge is at an angle
• Right and left types- can be
mesial or distal pairs
• Second number in the formula
• Used for rounding or bevelling
of the axiopulpal
line angle of two surface
preparations

48. .
95-100- pair used on
the distal gingival
margin
85-75- pair used to
bevel the mesial
margin
100 & 75 pairs- for
inlay/ onlay
preparations with
steep gingival
bevels
90 & 85 pairs- for
amalgam
preparations with
gingival enamel
bevels that decline
gingivally only
slightly

49. .
 The mesial gingival margin trimmer (13-85-10-14, R&L)
or the distal gingival margin trimmer (13-95-10-14,R and
L) is used to establish a slight cavosurface bevel at the
gingival margin (20 degrees) declining gingivally to
ensure full length enamel rods forming the gingival
margin.
 The sharp angles are rounded by rotational sweeping
with a GMT.

50.  The cutting edge makes an acute angle with the edge of the blade
farthest from the handle is termed distal and is used to bevel a distal
gingival margin or accentuate a mesial axiogingival angle.
 The cutting edge makes an acute angle with the edge of the blade nearer
to the handle is called mesial and is used to bevel mesial gingival
margin or accentuate a distal axiogingival angle.

51. ANGLE FORMER
 Has four unit instrument formula
 Paired instrument right and left
 Ring on the shank - right side instrument
 3 cutting edges ome primary cutting edge
and two secondary cutting edges (blade is
bevelled on sides and on edge)
 used to accentuate line and point angles
and creating retentive features in dentin
in preparation for gold restorations.
 Used in placing bevel on enamel
margins.
Combination of chisel and
GMT
Primary cutting edge

52. WEDELSTEDS CHISEL
 Shank and blade are curved
 Bevel on one side of blade
 Bevel towards the curvature of blade
– mesially bevelled
 Bevel away from curvature of blade
– distally bevelled
 Used for cleaving undermined enamel
and shaping walls
 Single instrument with three cutting
motion : Vertical , right and left

53. .
Off angle hatchet
 Instrument in which blade is rotated by 45
degrees from the plane of long axis of the
instrument
 Used to create and shape specific
angulations for cavity walls, especially in
areas of difficult access.
Triangular chisel
 Blade is triangular in shape with the base
away from the shaft.
 Has a terminal cutting edge like straight
chisel.
 Functions -

54. SPOON EXCAVATOR
 Modified hatchet
 Double ended instrument
 Binangle/triple angle
 Paired(right and left)
 Double plane instrument
 Circumferentially bevelled
 Cutting edge either circular (discoid carver)
or claw like (cleoid carver)
 Use scooping of softened carious material
 Carving amalgam or direct wax patterns

55. OTHER CUTTING INSTRUMENTS
 Knives - finishing knives, amalgam knives, or gold knives
 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.
 Sharp secondary edges on the heel aspect of the blade are very useful
in a scrape-pull mode.
Amalgam knives

56. OTHER HAND CUTTING INSTRUMENTS
Examples of other hand instruments for cutting.
A, Finishing knife.
B, Alternative finishing knife design emphasizing secondary cutting edges.
C, Dental file.
D, Cleoid blade.
E, Discoid blade carving amalgam.

57. FILES
 Files also can be used to trim excess restorative material.
 They are particularly useful at gingival margins.
 Blades of files are very thin, and teeth on the cutting surfaces
are short.
 The teeth of the instrument are designed to make the file
either a push or a pull instrument.

58. MOUTH MIRRORS
Flat mirrors- most commonly used and
preferred for most procedures,
concave (magnifying) mirrors are also
available.
• Two main types- rear-surface and
front-surface reflecting mirrors.
• The rear surface mirror
- Reflecting surface is on the back
surface of the mirror lens.
- Surface is less easily scratched.
- Produces a double or ghost image.

59. .
• 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.
• Rear surface mirror can be used
for general purposes and for
retracting the tongue and cheeks,
reserving the front surface mirror for
detailed examination.
Mirrors used for indirect vision

60. Different sizes of mirrors
Depending on diameter of head tops of mirrors sizes given are
no.2,3 and 4.

61. 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.

62. .
Uses
1) Indirect illumination.
- Mouth mirror could be held at an angle to reflect the light onto
the working area
2) Retraction
- Mirror head used to retract the patient’s lip or check or tongue
so that the clinician is able to view tooth surfaces.
-3)Protects from injury.
4) Indirect vision.
5) Guard.
6) Trans illumination.
- Only maxillary and mandibular anterior teeth can be
transilluminated
7) to check mobility,depressibility.
8) for performing percussion test

63. Mouth mirrors with illumination

64. Mouth mirrors with
suction

65. EXPLORER
 used as a diagnostic aid in evaluating condition of teeth especially
pits and fissures
Parts :
 Handle - is straight, could be plain or serrated.
 Shank - curved with one/more angle
 Working tip or tine is pointed.
Types of Explorer
 Straight explorer
 Shepherd’s Crook or curved explorer
 Interproximal explorer/Briault explorer/Back action probe

67. USES - Exploring lesion
- For detecting and assessing carious lesion in the tooth
- Detecting demineralised 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

68. Periodontal Probes
Though they almost look like
explorers but they have blunt
end which is marked with
gradations.
They are used for measuring
pocket depth and tooth
preparations.
In operative dentistry used to
determine dimensions of
instruments and various
features of preparations or
restorations
a)Straight probe b)briault probe
c) Graduated probe d) furction
probe e)CPITN probe

69. TWEEZERS
 These have angled tip and are available in different sizes.
 They are used to place and remove cotton rolls and other
small materials.
Cotton pliers and locking tweezers
Articulating paper forceps

70. RESTORATION INSTRUMENTS
 Following are the commonly used instruments when
temporary or permanent restoration is to be mixed.
Cement Spatulas
 Several types of spatulas are available in the market differing
in shape and size . On the basis of size, cement spatula can
be classified into two types :
Large and small cement spatula

71. .
 1. Large cement spatula: Mixing of luting cements
 2. Small cement spatula: Mixing of liner
Cement spatula also can be classified on the basis of
thickness such as rigid and flexible. Their use depends on
viscosity of cement and personal preference.
Different types of cement spatulas

72. PLASTIC FILLING INSTRUMENT
 Instruments used for carrying the
mixed base cements which are in soft
stage from cement spatula to the
cavity
 They are used to mix, carry and place
cements
 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.

73. CONDENSERS
 Come in single and double-ended designs.
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.
Mechanical type
Hand type

74. .
Nibs may be
-Of different shapes
1) Round
2) Elliptical
3) Diamond
4) Triangular
5) Paralellogram
6) Rectangular
-Of different sizes
Large round condensors
Small round condensors
-Depending on working end (condensor
face)
Serrated – for direct filling gold
Smooth – for silver amalgam
restorations

75. MORTONSON CONDENSOR
MARQUETTE CONDENSOR

76. GOLD CONDENSORS
 Hand condensors-
 Handle six inch in length.
 Has one blunt end to receive blow from the mallet.
 Shank may be straight, monoangled or offset.
 Nibs can be round, rectangular and parallelogram shaped.
 Pyramidal or wedge like serrations are present on the face of condensors to
increase their surface area

77. .
 Hand mallet- long handled condensors with leather
faced malets (50 gms in weight)
 Automatic hand mallet-spring loaded instrument is used
 Electric malleting-(Mc Shirley electromallet)
 Pneumatic mallet(Hollenbeck condensor)
Vibrating condensors with detachable tips run by
compressed air

78. AMALGAM CARRIERS
 Carry the freshly prepared amalgam
restorative material to the prepared
tooth.
 Have hollow working ends, called
barrels, into which the amalgam is
packed for transportation
 Carriers can be both single and
double ended. Barrel of amalgam
carriers comes in a variety of sizes
viz ; small, large and jumbo
 Lever of amalgam carrier is located
on the top of the carrier. When lever
is depressed, the amalgam is
expelled into the preparation.

79. CARVERS
 Carvers are used to contour the restoration approximately same to
original tooth structure.
 Sharp cutting edges present in carvers are used to shapen and
form tooth anatomy from a restorations.
 Carvers come in different shapes and sizes in double ended
designs

80. .
- Hollenback carver (Knife- edged
– elongated bibevelled)
- Diamond (Frahm’s) carver –
Bibevelled cutting edge
- Wards ‘C’ carver
- 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

81. BURNISHER
 used for:
• Final condensation of amalgam.
• Initial shaping of occlusal anatomy of amalgam.
Shape metal matrix bands to impart more desirable contour to the
restorations
 Commonly used are: small ball burnisher
Rounded cone-shaped burnisher.
Beavetail or egg shaped condenser—narrow type of burnisher.
Ovoid burnisher—comes in various sizes such as 28,29, 31.

82. Beaver tail shaped
Round shaped
Egg shaped

83. LABORATORY INSTRUMENTS
.
PKT NO.1
PKT NO.2
PKT NO.4
PKT NO.3
PKT NO.5

84. P K T INSTRUMENTS
 P.K. Thomas Waxing Instrument Set, 5 pcs, L-PKT. The feather
weight aluminum handle offers extremely comfortable handling to
reduce hand and wrist fatigue. Color coded: Yellow (PKT 1), Green
(PKT 2), Blue (PKT 3), Red (PKT 4) and Silver (PKT 5). The set
comes in a nice hard plastic case.

85. COMPOSITE RESIN INSTRUMENTS
 A wide range of double ended
instruments are used to
transport and place resins.
 The working ends on these
instruments range from varying
small cylinders to angled,
paddle like shapes
 Composite resin instruments
are made of plastic or
titanium nitride coating.
 They do not discolor or
contaminate the composite
restoration, also the composite
resin material does not stick to
the instrument.

86. Hand instruments for composites

87. Top tips from Dentsply
• The special surface of Dentsply Ash composite
materials enables them to be used with composite
and glass ionomer materials.
• Anodised aluminium
• Placing and shaping composite material is
significantly easier and quicker
• The anodised surface of the composite instrument
is not scratched by the
composite filler particles and it also resists
composites sticking to it without risk of discolouring
the materials.
• Dentsply Ash composite instrumentsare available in
Ceramicolor and Lustra.

88. Optra contact- Ivoclar vivadent
OptraContact is easy to use and highly effective. The instrument is
used to achieve large and tight proximal contacts in posterior teeth.

89. OptraContact features a patented forked working end with which a composite
bridge is formed while the first layer is cured. The bridge, which is created in the
contact region, stabilizes the matrix. Furthermore, OptraContact allows contacts to
be selectively created in the anatomically-correct upper third of the proximal
surface. OptraContact is available in two sizes: one for molars and one for
premolars or for large and small cavities.

90. Advantages
Tighter and larger proximal contacts
The stabilizing composite bridge makes the proximal contacts tighter and larger.
Selective positioning of contacts
Contacts can be selectively positioned in the upper third of the proximal surface.
Consequently, the entire restoration is located much nearer to the original natural
position

91. OPTRASCULPT PAD
 Optrasculpt pad is a contouring
instrument with special form pad of
attachments which is designed for
the efficient, nonstick forming and
shaping of composites.
 Highly synthetic foam pads
 Nonstick surface of the foam pad
attachments prevents the adhesion
of composite resin
 Suitable for adapting, contouring
uncured packable composite and
compomer materials in class 3, 4
and 5 restorations and direct
laminate veneers

92. #3 Goldstein Flexi-Thin XTS
Composite Instrument with #6S
Smooth Satin Steel Handle
NB Anterior Composite placement
instrument

93. Garrison Dental universal
Composite &
plastic filling instruments

95. Slix™ Composite Manipulation Instruments
Nonstick - Durable – Ergonomic - Autoclavable
The tips are treated with a revolutionary protective coating that provides superior non-
stick properties and a lustrous surface for long lasting esthetic appearance. No more
composite sticking; dentists appreciate the easy placement and fast clean-up!
The ergonomic handles are manufactured from an advance technology polymer with
medical-grade silicone grips. “Surprisingly light”-only 16g - on the largest available
handle (1/2” (1.27 cm) diameter) to reduce hand fatigue

97. INSTRUMENT GRASPS
 correct instrument grasps are important for achieving success in
operative procedures
 correct grasp is selected according to the instruments being used,
position of instrument being used, the operator, the area which is
being operated and the specific procedure to be done.
Commonly used instrument
grasps in operative dentistry
1. Modified pen grasp
2. Inverted pen grasp
3. Palm and thumb grasp
4. Modified palm and thumb grasp.

98. Modified pen grasp Inverted pen grasp
Palm and thumb grasp

99. RESTS
 Helps to stabilize the hand and the instrument by providing a
firm rest to the hand during operative procedures.
 Finger rests may be intraoral or extraoral
Intraoral finger rests:
a. Conventional
b. Crossarch
c. Opposite arch
d. Finger on finger

101. .
 2. Extraoral finger rest: It is used mostly for maxillary
posterior teeth.
 a. Palm up b. Palm down


102. GUARDS-
• Hand instruments or other items, such as interproximal wedges, used
to protect soft tissue from contact with sharp cutting or abrasive
instruments.

103. SHARPENING OF HAND INSTRUMENTS
 Instrument sharpening is a critical component of
operative dentistry
 A sharp instrument cuts more precisely and quickly
than dull instruments.
 Therefore to avoid wasting time on using dull
instruments, dentists must be thoroughly familiar
with principles of sharpening

104. GOALS OF SHARPENING
 • To produce a functionally sharp edge.
 • Maintain the contour (shape) of instrument.
 • Maintain the life of instrument.
Advantages of Sharp Instruments
• Improved efficiency.
• Improved tactile sensations.
• Less pressure and force.
• Improved instrument control.
• Minimized patient discomfort.
• Less treatment time.

105. PRINCIPLES OF SHARPENING
Select the appropriate type of stone for type of instrument to be
used.
• Instrument should be clean and sterile before sharpening.
• Establish proper angle between stone and surface of
instrument on the basis of design.
• Lubricate the stone during sharpening as it reduces the
clogging of sharpening stone and heat generated during
sharpening.
• Stable and firm grip of both instrument and stone is required
during sharpening. Maintain the proper angulation
throughout sharpening strokes.

106. .
• Sharpening should be done with light stroke or pressure. Avoid
excessive pressure.
• When sharpening is completed observe the cutting edge for
wire edges. Wire edges should be removed. (Wire edges are
unsupported metal fragments that extend beyond the cutting
from the lateral side or face of blade).
• Resterilize the sharpened instruments.

107. DEVICES USED FOR SHARPENING
 Mechanical
bench type piece of equipment in
which honing disks
On top disk rotates up to 7,000
rpm. e.g. honing machine.
 Mounted Stones
In this, stones are mounted on
metal mandrel and used with
slow speed handpiece. Most
common mounted stones are
Arkansas and ruby..
Mechanical sharpners

108. Various shapes such as cylindrical,conical or disk shaped are available. Mounted
stones are not preferred in routine because they:
1. Tend to wear down quickly.
2. Result in generation in frictional heat.
3. Difficult to control during sharpening

109. .
 Unmounted/Handhold Stones
 come in variety of sizes and shapes. Stone can be rectangular with
flat, rectangular with grooved surfaces or cylindrical in shape.
 Flat stone is ideal for moving technique.
 Cylindrical stone for removing wire edges

110. .
 Stone type can come in natural or synthetic form:
 1. Natural–Arkansas (preferred)
 2. Synthetic
• India stone
• Ceramic stone
• Composition stone

111. STERILISATION AND DISINFECTION
STERILISATION – Destruction of both vegetative form and bacterial
spores.
DISINFECTION- destruction of only vegetative form.
Procedures involved in instrument processing:
 1)presoaking
 2)cleaning
 3)corrosion control and lubrication
 4)sterilisation
 5)sterilisation monitoring
 6)drying or cooling
 7)storage
 8)distribution
 9)sharpening

112. .
Presoaking-
Prevent drying
Begin to dissolve or soften organic debris
Begin microbial kill in some instances
Presoak solution contains
-Detergents
-Enzymes or detergent containing disinfectant such as phenolic
compounds or quaternary ammonium compounds.

113. Cleaning
Manual: hand scrubbing with soft brush under water
to prevent aerolising and splashing
Ultrasonic : safest and most efficient way to clean

114. .
3)Corrosion control and lubrication
A rust inhibitor should be applied on non stainless steel instruments.
Lubrication of instruments with moving parts should be done prior to
steam sterilisation
Water based lubricants that contain preservative are ideal.

115. 4)Packaging-
Cleaned instrument are wrapped before sterilisation
-See through poly film bag
-Single layer cloth wrap
-Nylon plastic tubing
5)Instruments in tray and cassette
Retain instruments at chair side and during ultrasonic cleaning, rinsing and
sterilisation

116. .
5)Sterilisation
4 accepted methods
-steam pressure sterilisation(autoclave)
-Chemical vapor pressure sterilisation(chemiclave)
-Dry heat sterilisation(dryclave)
-Ethylene oxide sterilisation
-New methods
Microwave
Ultraviolet light

117. STEAM PRESSURE STERILISATION
 Time required
 -15 min at 250 degree F(121
degree C) and 15 lbs pressure
 Most rapid and effective method
of sterilising cloth surgical packs
and towel packs.
Disadvantages:
 Items sensitive to elevated
temperature cannot be sterilised
 Tends to rust carbon steel
instruments and burs.

118. CHEMICAL VAPOR STERILISATION
(CHEMICLAVE)
 Operate at 270 degree
F(131 degree C) at 20 lbs for
half an hour
 Carbon steel and burs are
said to be sterilised without
getting rusted.
-Disadvantages
Only dry instruments should be
loaded
Towels and heavy cloth
wrapping may not be
penetrated to provide
adequate sterilisation.

119. DRY HEAT STERILISATION
Conventional dry heat oven
 -heated at 320 degree F(160
degree C) for 30 min.
 Instruments should be
packaged in foil wrap or nylon
bags.
Short cycle high temperature by
dry heat oven
Sterilisation time reduced
-6 min for unwrapped
-12 min for wrapped
Temperature – 370-375 degree F.

120. ETHYLENE OXIDE STERILISATION
 Best method for sterilising complex instrument and delicate
materials.
 Expensive
 DISINFECTION
Boiling water – 10 min
Use of chemicals-6 to 10 hrs
glutaraldehyde-2-3%
Sodium hypochlorite 1-5%

121. .
6)Sterilisation monitoring
Sterilisation indicator on instrument bag
Daily color change process indicator strip
Weekly biologic spore test
Documentation note book
7) Storage-
-in a sterile , wrapped tray set up or in an individual sterile wrapping

122. CONCLUSION
 The removal and shaping of tooth
structure are essential aspects of
restorative dentistry. Modern high speed
equipments has eliminated the need for
many hand instruments for tooth
preparation , but hand cutting
instruments are still important for
finishing many tooth preparations and
thus hand cutting instruments remain an
essential part of the armamentarium for
quality restorative dentistry.

123. References
• Sturdevant’s Art and Science of Operative dentistry (4th
edition)
• Operative dentistry- modern theory and practice-Marzouk,
Simonton and Gross (1st edition)
• Principles and practice of Operative dentistry by Gerald
T.Charbenau (2nd edition)
• Atlas of operative dentistry- William W Howard, Richard C
Moller (3rd edition)
• History of dentistry- Melvin E Eing
• Text book of operative dentistry- Gilmore, Lund, Bales,
Vernetti (4th edition)
• Current concepts in Operative dentistry- Goldman,
Gilmore, Inby, McDonald (6th volume)
• Modern concepts in operative dentistry- Horsted, Ivar, Mjor
• Pickard’s manual of operative dentistry (5th edition)
• Mosby Dental hygiene – Michele L Darby (5th edition)