Periodontal instruments and armamentarium with their application 245 slides

Introduction
Classification of Periodontal instruments
Parts of instruments
Mouth Mirrors
Periodontal Probes
Explorers
Scalers
Curettes
• Universal Curettes
• Area specific Curettes
• Extended Shank Curettes
• Curvettes
• Langer and Furcation Curettes
2

File,Chisel and Hoes
Mechanized Instruments
Polishing Instruments
Surgical Instruments
 Excisional and incisional instruments
 Surgical curettes and sickles
 Periosteal elevators
 Surgical chisels & files
 Scissors
 Needle holders
EVA System
Conclusion
3

 Since ancient times when dental therapists recognized the
importance of removal of calculus and dental plaque as a
treatment for gum disease, instruments were specifically
designed to affect the procedure.
 Tooth scalers and "scalper medicinalis" were used by the Romans
since the time of Celsus, who suggested that stains on teeth can
be scraped away.
4

 An elaborate set of 14 double ended instruments was used
by Albucasis (936-1013 AD.), a Moorish physician. These
instruments were primarily hooks or straight and slightly
curved gravers (chisel-like scrapers).
5

As with all instruments, they have three distinct sections:
 Handle,
 Shank, and
 Working end, blade or nib
7

Handle
 Handle of the instrument is used for grasping the
instrument.
 Available in various weight ,diameter and texture.
Weight:-
Weight of the handle is determined by its diameter and
its core(solid or hollow)
 Hollow handle: increase tactile transfer and minimize
fatigue
 Solid handle :reduce tactile transfer and increase
fatigue
8

Diameter
 Small handles(3/17 inch) :decrease control and increase
fatigue
 Large handless (3/8 inch): maximize control and reduce
muscle fatigue
Texture
 Serrated knurled handle(bumpy texturing) :maximize
control and decrease hand fatigue
 Smooth handle :decrease control and increase muscle
fatigue
9

Handle Selection Criteria
10
Recommended Avoid
Large diameter (3/8 inch) Small diameter (3/17 inch)
Lightweight, hollow handle Heavy, solid metal handle
Bumpy texturing Smooth or ﬂat texturing

Shank
 Shank connect the handle to the
working end of the instrument.
 Shank can be functional and
terminal
Functional shank extend from the
working end to the
shank bend closest to instrument
handle
Terminal shank extends between
blade and 1st bend
Shank can be rigid, moderately rigid
or flexible.
12

1. Simple shank design—a shank that is bent in one plane
(front-to-back).
2.Complex shank design—a shank that is bent in two
plane(front –to-back and side –to-side) to facilitate
instrumentation of posterior teeth
13

Working end
 The working end or blade is made up of several
component such as face ,cutting edge ,back and toe .
 A rounded working end is called – TOE
 A pointed working end is called – TIP
 BALANCED INSTRUMENT
 If the working –ends are aligned with the long axis of
the handle. This design that finger pressure applied
against handle is transferred to the working –end of
the instument.
14

 Periodontal instruments are designed for specific
purposessuch as removing calculus, planing root
surfaces, curetting the gingiva, and removing diseased
tissue.
15

Periodontal Instruments are classified according to the purposes
they serve as follows-
1. PERIODONTAL PROBES are used to locate, measure
and mark pockets as well as determine their course on individual
tooth surfaces.
2. EXPLORER are used to locate calculus deposits and caries.
3.SCALING,ROOT-PLANING AND CURETTAGE
instruments are used for removal of plaque and calcified deposits
from the crown and root of a tooth ,removal of altered cementum
from the subgingival root surface and debridement of the soft
tissue lining the pocket.
18

Scaling and curettage instruments are classified as follows :-
Sickle scalers are heavy instruments used to remove
supragingival calculus.
Curettes are fine instruments used for subgingival scaling,root
planing and removal of the soft tissue lining the pocket.
19

Hoe,chisel and file scalers are used to remove tenacious
subgingival calculus and altered cementum. Their use is limited
compared with that of curettes.
Ultrasonic and sonic instruments are used for scaling and
cleansing tooth surfaces and curetting the soft tissue wall of the
periodontal pocket .
20

4)Periodontal Endoscope is used to visualize deeply
into subgingival pockets and furcations, allowing the detection of
pockets.
5)Cleansing and polishing instruments such as
rubber cups,brushes and dental tapes are used to clean and polish
tooth surfaces.
Also available are air- powder abrasive systems for tooth
polishing.
21

Mirror Surfaces -
1.Plane ( Flat ) . May produce a double image .
2.Concave - For magnifying
3. Front Surface -The reflecting surface is on the front of the lens
rather than on the back as with plane or magnifying mirror. The
front surface eliminates “ ghost images “.
22

Diameter –
Size of mouth mirror
Size 1 -16mm
Size 2 – 18mm
Size 3 – 20mm
Size 4 - 22mm
Size 5- 24 mm
Most commonly used mirror are size 4 and size 5.
23

Disposable Mirrors
May be plastic in one piece or may be a handle with replaceable head
for professional use.
 Also there are Take home mirrors for patient instruction . Patient may
observe lingual and posterior aspects .
24

Different types of mouth mirror
25

26
Plane surface mirrors (also know as regular mirrors) have a silver coating on
the back of the glass. As a result, light is reflected from the top of the glass as
well as from the silver layer. This causes a double image.

FUNCTIONS
Specific uses
Indirect vision
Indirect illumination
Transillumination
Retraction
Nonspecific uses
Handles can be used for checking mobility, percussion.
;
27

 Periodontal probes are used to locate, measure and mark pockets as
well as determine their course on individual tooth surfaces .
 It is usually long, thin, and blunted at the end.
 The markings are inscribed onto the head of the instrument for
accuracy and readability.
28
PERIODONTAL PROBES

 Function : to measure the depth of the pockets.
 General characteristics :
- tapered
- straight
- millimeter calibration
- blunt, rounded tip
- thin ( 0.5 mm at the end )
- the shank is angled to allow easy insertion
in the pocket.
29

Probe is used to
A. Assess the periodontal status for preparation of a treatment
plan
1. Classify the disease as gingivitis or periodontitis by determining
whether the bone loss has occurred and whether the pockets are
gingival or periodontal.
2. Determine the extent of inflammation in conjunction with overall
gingival inflammation. Bleeding on probing is an early sign of
inflammation in the gingiva.
30

B. Make a Sulcus and pocket survey
1. Examine the shape ,topography and dimension of sulci and
pockets.
2. Measure and record probing depths.
3. Determine the clinical attachment level .
C. Make a Mucogingival Determinations
1.Determine relationship of gingival margin, attachment level
and mucogingival junction .
2. Measures width of attached gingiva
3. Roll test to locate mucogingival junction
31

D. Make Other Gingival Determinations
1.Evaluate gingival bleeding on probing and prepare a index.
2. Measure the extent of visible gingival recession.
3. Detect anatomic configuration of roots, subgingival deposits
and root irregularities that complicate instrumentation. For this,
the probe is used in conjunction with the explorer.
F. Evaluate Success and completeness of treatment
32

 Periodontal probes are classified as
1 st generation probe
2nd generation probe
3 rd generation probe……Pihlstrom
4 th generation probe…….Watts
5th generation probe
33

These include-
William’s periodontal probe
UNC-15 probe
University of michigan O probe
Marquis colour coded probe
Goldman Fox probe
WHO probe
Nabers probe
34
ADVANTAGES
1.Easily available and inexpensive
2.Tactile sensation is preserved
3.Colour coding
4.Can be used even in presence of
subgingival calculus
DISADVANTAGES
1.Probing force cannot be measured
2.Heavy in weight
3.Inter-examiner variation
4.No computer capturing data
5.Assistant is required to record the
reading

WILLIAMS GRADUATED
PERIODONTAL PROBE
35
•Charles H.M. williams in 1936 introduced
graduated periodontal probe.
•It is stainless steel probe with diameter
1mm ,length 13mm and blunt tip end.
•Angle between handle and probe tip is 130*
•Markings include 1,2,3,5,7,8,9 and 10 mm
with 4mm and 6mm marking are missing in
this probe to improve visibility and avoid
confusion in reading the marking
.

Goldman Fox probe
Goldman-Fox probe same as Williams
probe`s calibration
- But it is flattened not round
36

Glickman periodontal probe
37
It has rounded tip with longer shank

The UNC-15 Probe
38
15mm long.
Markings are at each mm and
color coding at the 5th,10th and
15thmm

39
UNIVERSITY OF MICHIGAN O PROBE
WITHOUT WILLIAMS MARKING
Markings are at 3, 6, and 8mm

MARQUIS COLOUR CODED
PROBE
40
•Calibrations are in 3mm sections.
Markings are 3,6,9,12mm

WHO PROBE
41
• It has 0.5 mm ball at the tip
• millimeter markings at 3.5/ 5.5/ 8.5/ 11.5
mm
• color coding from 3.5 to 5.5 mm.

Types:
CPITN-E(Epidemiological) -Markings at 3.5 and 5.5mm.
CPITN-C (Clinical )- Markings at 3.5, 5.5, 8.5 and 11.5mm.
This probe was designed for
Measurement of pocket depth
Detection of sub gingival calculus
Used in assessment of treatment needs CPITN-C
42
CPITN -E

NABER’S PROBE
43
It is used to determine the extent of
furcation involvement on a multi-rooted
teeth .
It has a curved working end for
accessing the furcation area.
The end is blunt so that it will not harm
the soft tissues .
Markings. at 3,6,9 and 12mm

PLASTIC PROBES FOR IMPLANTS
Several different companies are manufacturing plastic
instruments and gold –coated curettes for use on titanium and
other implant abutment metals.
It is important that plastic rather than metal instruments be used
to avoid scarring and permanent damage to the implants.
44

These are pressure-sensitive probes.
It has been shown that with forces upto 20 gms, the probe tips
remains within junctional epithelium and forces upto 50 gms are
necessary to diagnose osseous defects.
This probe did not solve many problems of conventional probes
and lacked tactile sensitivity.
Examples are TPS probe.
Advantages Disadvantages
1) Constant pressure 1) Penetration into inflammed
2) Less inter-examiner variation connective tissue
3) Comfortable to the patient 2) Assistant required
45

True Pressure Sensitive Probe
 To overcome the limitations of conventional probing
system, pressure-sensitive probes are developed which
have standardized, controlled insertion pressure.
 Introduced by hunter in 1994.
 These probe have a disposable probing head and a
hemisphere probe tip with a diameter of 0.5 mm
 This probe was designed to deliver the same 20 grams
of force every time.
 Controlled force to the probe tip was provided using a
parallelogram.
46

True Pressure Sensitive Probe
47

These are computerized probes. Gibbes et al designed Florida probes
ex- Foster miller probe ,toronto automated probes which can detect
cemento- enamel junction.
ADVANTAGES
1)Constant pressure application
2)Error during data recording minimal
3)Computerized storage of data
4)Printout can be obtained
DISADVANTAGES
1)Penetration into inflamed connective tissue may occur
2)Less tactile sensitivity
48

Foster Miller probe
 Introduced by Jeffcoat et al in 1986
 This device capable of providing controlled probing
pressure and measuring the pocket depth along with
detection of CEJ.
 The components of the probe are: a pneumatic
cylinder, a linear variable differential transducer
(LVDT), a force transducer, an accelerator, and a probe
tip.
 The main mechanism of action of the Foster-Miller
probe is by detection of the CEJ
49

 The ball tip moves or glides over the root surface at a
controlled speed and preset pressure. Abrupt changes
in the acceleration of the probe movement (recorded
on a graph) indicate when it meets the CEJ and when
it is stopped at the base of the pocket
50

The Florida Probe was devised by Gibbs et al in 1988.
This probe consists of a probe handpiece and sleeve; a displacement
transducer; a foot switch; and a computer interface/personal computer.
The hemispheric probe tip has a diameter of 0.45 mm, and the sleeve
has a diameter of 0.97 mm.
Constant probing pressure of 15 gm is provided by coil springs inside
the handpiece
Its advantages are
Precise Electronic measurements
Computer storage data
Constant probing force 51
FLORIDA
PROBE

Disadvantages are-
Lack tactile sensitivity
Underestimation of deep probing depths
by the automated probe.
52

53
Florida probe with stent
Florida probe without stent

Fourth generation
These are three dimensional probes in which sequential probe
positions are measured.
ADVANTAGES
1)Allow three –dimensional measurement
2)Sequential probe positions can be measured
3)Computerized storage
4)Printout can be obtained
DISADVANTAGES
1)Under developed
54

Fifth Generation.
 Fifth generation are ultrasonographic probes which provides
painless probing to the patient. The guidance path is predetermined
in these probes.
 ADVANTAGES
1)Non –invasive
2)Accurate measurement of pocket depth
3)Ultra sound waves accurately detect various periodontal structure
like upper boundary of periodontal ligament and other soft tissue
structure
4)Provides information regarding condition of the gingival tissues.
5)Printout can be obtained.
DISADVANTAGES
1)Technique sensitive
2)Expensive
3)Operator training required for interpreting the image obtained. 55

UltraSonographic (US) probe
 US probe was devised by Hinders and Companion at
the NASA Langley Research Center.
 US probe mapping system is a non –invasive
periodontal probing
 A narrow beam of high frequency (10-15 Hz)
ultrasonic waves is passed into the gingival sulcus and
echoes of returning waves ,which are reflected back
from tissues are recorded.
 Component of the probe contra-angled
handpiece,computer, electron box for water control,
foot pedal, transducer emit and receives sound waves.
56

Thermal Probe
 Thermal probes are sensitive diagnostic devices used for
measuring early inflammatory changes in the gingival
tissues.
 One of the commercially available system, the
PerioTemp Probe enables the calculation of temperature
differential (DT, with a sensitivity of 0.1o C) between the
pocket probed and its sub gingival temperature.
 This temperature differential is useful because it allows
consideration of differences in core temperature
between individuals.
59

Thermal Probe
 Sub gingival temperature at diseased sites is increased
compared with healthy sites.
 There always exists a natural antero - posterior
temperature gradient existing within the dental arches.
 Mandibular sites were reported to be warmer than the
maxillary sites.
 Temperature increases with probing depth due to
increase in cellular and molecular activity caused by
increased periodontal inflammation with increasing
probing depth.
61

Flexible Plastic Probes
 The Colorvue™ Probe Tips from Hu-
Friedy Manufacturing offer the option
of using replaceable and flexible tips
with 1 mm or 3 mm markings.
 The yellow probe with the black
markings creates a striking contrast with
the gingival tissue. Tips last 30 uses due
to wearing of the color markings.
62

 The PerioWise® Friendly
Probe® by Premier Dental is a
white, flexible, autoclavable 3-
6-9-12 mm or 3-5-7-10 mm
probe. At the tip is a green
band indicating a 3 mm or less
sulcus depth. Red millimeter
markings are present at 5 mm
or 6 mm and thereafter
indicating disease.
63

Explorers are sharp, pointed metallic instruments.
Functions-
These are used to detect by tactile means , the texture ,and character of tooth surfaces
before,during and after periodontal debridement to assess the progress and completeness of
instrumentation.
They are also used to detect tooth surfaces for calculus ,decalcified and carious lesions,
dental anomalies and anatomic features such as grooves , curvatures or root furcations .
.
64
EXPLORER

Design of Explorers
 Explorers are made of flexible metal.
 Explorers are circular in cross section.
 The working-end is 1 to 2 mm in length and is referred to as the
explorer tip.
 The actual point of the explorer is not used to detect dental calculus;
rather,the side of explorer tip is applied to the tooth surface
65

SHEPHARDS HOOK
66
It is a long stick with a curved end
USE
For supragingival examinations for
dental caries and irrregular margins
of restoration

Straight Explorer.
 Use:
 • Supragingival examination of the
margins of restorations or to assess for
sealant retention.
67

Curved Explorer.
 Use:
 Calculus detection in normal sulci or
shallow pockets.
68

COWHORN &PIGTAIL
69
•Used in calculus detection in
normal sulci or shallow
pockets extending no deeper
than the cervical-third of the
root.

ORBAN TYPE
70
•Used for assessment of anterior root
surfaces and the facial and lingual surfaces
of posterior teeth .
• Difficult to adapt to the line angles and
proximal surfaces of the posterior teeth
Tip bent at a 90-degee to the lower shank

11/12 EXPLORER
71
It is a universal assessment /diagnostic periodontal
instrument.
The tip is at 90-degree angle to lower shank.Used for
assessment of root surfaces on posterior and anterior teeth

These have a flat surface and two cutting edges that converge in a sharply pointed tip.
The shape of the instrument makes the tip strong so that it will not break off during
use . These is primarily used to remove supragingival calculus .
 Because of the design of this instrument it is difficult to insert a large sickle blade
under the gingiva without damaging the surrounding gingival tissues .
Small, curved sickle blades such as 204SD can be inserted under ledges of calculus a
few millimeters below the gingiva .
72
SICKLE
SCALER

Working-End Design
PARTS OF THE WORKING-END
73
Cutting Edge. The cutting edge is a sharp
edge formed where the face and lateral
surfaces meet

 Toe or Tip:The cutting edges of a curette meet to form a
rounded surface called a toe. The cutting edges of a
sickle scaler meet in a point called a tip.
74

A curette is the instrument of choice for removing deep
subgingival calculus,root planing altered cementum and removing
the soft tissue lining the periodontal pocket .
Each working end has a cutting edge on both sides of the blade
and a rounded toe .
The curette is finer than sickle scalers and does not have any
sharp points or corners other than the cutting edge of the blade
.
75
CURETTE

 A universal curet is a periodontal instrument used to remove small- and
medium-size calculus deposits .
 Universal curet can be used both supragingivally and subgingivally—on crown
and root surfaces.
 A universal curet usually is a double-ended instrument with paired, mirror-
image working-ends.
Example : langer curettes, columbia curettes, indiana university curettes, barnhart
curettes, mc-call’s curettes, younger good curettes.
76

 The face is at a 90-degree angle with terminal ( lower ) shank.
 Two cutting edge which are formed at the junction of the lateral
surface with the facial surface.
 Two parallel cutting edges that meet at a rounded toe.
77
Design

 Paradise Dental Technologies (PDT) (Missoula, Mont) introduced the
original Montana Jack scaler, a double ended, curved posterior sickle
scaler.
 New Rigid Montana Jack for heavier scaling that has larger shanks with
blades that are as narrow as the original Montana Jack but thicker face
to back.
78

 The Nevi 1 anterior sickle scaler has two distinct working ends. The small
thin sickle end is paired with an oval disk-shaped end.
 The Nevi 2 is a double ended acutely curved posterior sickle that is very
thin.
 The new Nevi 3 is a modification of the Wiland Carver that was originally
designed as a restorative finishing instrument. Its thin curved blades for
light to moderate scaling in shallow to moderate depths. The Nevi 3 is also
excellent for scaling of malpositioned teeth and for scaling pediatric
patients.
 The new Nevi 4 is a modified Montana Jack design that has strong, curved
blades that are designed for moderate to heavy scaling.
79

LANGER
This set of four curette combines the shank design of the standard gracey with a
universal curettes blade design .
This combination allows the advantage of the area-specific shank to be combined
with the versatility of the universal curette blade.
1/2langer :mandibular posterior
3/4 langer: maxillary posterior
5/6 lager : anterior
17/18 langer :posterior
81

After Five Langer Curettes
 Elongated terminal shank (3mm) provides better clearance around
crowns, and superior access to root contours and pockets 5mm or more
in depth.
 Blade thinned by 10% to ease gingival insertions and reduce tissue
distention
83

Mini Five Langer Curettes
 Designed with the same elongated
terminal shank (3mm) and thinned
blades as the After Five Langer Curettes
 50% shorter blade for access to smaller
roots, narrow pockets, furcations, and
developmental groove
84
Standard Mini FiveAfter Five

Gracey curettes- In 1940s dr. Clayton gracey developed gracey
curettes.
 These are representatives of the area-specific curettes, a set of
several instruments designed and angled to adapt to specific
anatomic areas of the dentition.
These curettes and their identification are probably the best
instruments for subgingival scaling and root planing because they
provide the best adaptation to complex root anatomy.
85
AREA SPECIFIC
CURETTES

1. Blade is at 70 degrees from the lower shank (offset blade). This angulation
allows the blade to be inserted in the precise position , provided parallel lower
shank with the long axis of the tooth surface being scaled.
2. One cutting edge
3. A long, complex functional shank
86
Design of Gracey curette

Universal curetteGracey curette
All areas and surfacesspecific surfacesArea of use
two cutting edgeOne cutting edgeUse of cutting edge
Curved in one planeCurved in two planesCutting edge curvature
Not Offset , 90 degreesOffset blade, 70 ْBlade angle
87
Universal curetteGracey curette

 Gracey and hugo friedman ,together developed a
series of 14 area –specific curettes.
 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 .
89
Double-ended Gracey curettes
are 7 instruments

 The 15/16 Gracey Curette was introduced in 1993
 It is a modification of the standard 11-12
 Combines a Gracey :
#11-12 blade with a
#13-14 shank .
 It is allows better adaptation to posterior mesial
surfaces, especially on the maxillary molars with an
intraoral finger rest.
 The terminal shank is 9 mm
90
Gracey #15-16

 The 15/16 Gracey Curette (right) has the same shank design as
the 13/14 (left); however, the blade is finished like an 11/12
(center) for the posterior mesial surfaces.
9113/14 11/12 15/16

17/18 Gracey Curette
 The 17/18 Gracey Curette is modified version of the Gracey 13-
14 allows better access and a more comfortable hand and finger
position access to the distal surfaces of posterior teeth.
 Accentuated angles and long terminal shank allows for placement
into deep periodontal pocket.
 The multiple bends improve the handle positioning so
interference from the opposing arch is significantly reduced.
 Reduced blade length enhances adaptation of the entire blade to
the tooth.
 The terminal shank is 7 mm
92

17/18 Gracey Curette
• With the 17/18’s multiple bends, the handle position is closer to
horizontal which minimizes the contact with the opposing arch.
Allowing the clinician improved access to difficult to reach posterior
areas.
93
13/14 Gracey
17/18 Gracey13/14 Gracey
17/18 Gracey

94
1. The terminal shank is 3 mm longer ( allowing
extension into deeper periodontal pockets of 5
mm or more).
2. A blade thinned by 10% . For smoother
insertion , and reduced tissue stretching.
3. 1mm shorter blade
4. Available After Five instruments :
#1-2, 3-4, 5-6, 7-8, 11-12, 13-14
Extended shank instruments
- After Five curette

 They are modifications of the After
Five curettes
 Features:
1. Blades are half the length of the
After Five or standard Gracey curettes.
2. Extended shank
- Advantages :
1. can be used easily with vertical
strokes,
2. With reduced tissue distention,
3. and without tissue trauma.
95
Mini-bladed curettes
- Mini Five-
Standard After Five Mini Five

Available in both:
- Rigid Mini Five Gracey curette( calculus removal)
- Finishing Mini Five Gracey curette (light scaling)
- Available in all standard Gracey numbers except for the # 9-10
Function:
1. Deep, narrow pockets,
2. Furcations,
3. Developmental grooves,
4. Line angles,
5. Deep, tight pockets.
96

Micro Mini Five Gracey
Curettes
• Blade is 20% thinner than a Mini Five Gracey to
further reduce tissue distention and ease sub-
gingival insertion.
• Elongated terminal shank for access into deep
periodontal pockets and root surfaces of 5mm
and more.
• Slightly increased shank rigidity compared to
traditional Mini Five Gracey Curettes
97
Micro Mini
Five Gracey

Vision Curvettes
The curvettes are modification of gracey curettes .
These modifications include
 50% shorter blade
 Increased blade curvature
 Straighter and longer terminal shank
 Blade I.D. mark 5mm and 10mm
Markings on the shank
98

99
+
OUTLINE OF
VISION CURVETTE
(solid)
OUTLINE OF
GRACEY CURETTE
(dashed)
SGCSUB0 – SUB-0
For anterior teeth.
SGC1/2 – Curvette 1/2
For anterior and premolar surfaces.
For mesial posterior surfaces and furcations;
elongated shank, 1 band on handle for easy
identification.
For distal posterior surfaces and furcations;
elongated shanks; 2 bands on handle for easy
identification.

KRAMER-NEVINS PERIODONTAL
SURGICAL CURETTE
100
Larger and heavier curettes for the
removal of granulation tissue and
tenacious subgingival deposits.

TURGEON MODIFIED GRACEY
CURETTE
 The Turgeon Modified
Gracey features narrow
blades for ease of insertion.
101

QUETIN Furcation curettes
These are actually hoes with a shallow, half moon radius that fits into root
or floor of the furcation.
The curvature of the tip also fits into developmental depressions on the
inner aspects of the roots.
The shanks are slighty curved for better access and tip are available in two
widths .
These remove burnished calculus from recessed areas of the furcation
where even the mini-bladed curettes are often too large to gain every access.
Example BL 1 and MD1 small and fine with 0.9mm blade width and
BL2 and MD 2 Large and wider with 1.3 blade width
102

103
Quétin furcation curettes : BL2 (larger) and BL1 (smaller).

PERIOTRIEVERS
The schwartz Periortrievers are a set of two double-ended, highly
magnetized instruments designed for the retrieval of broken instrument
tips from the periodontal pocket.
They are indispensable when the clinician has broken a curette tip in a
furcation or deep pocket.
104

Periodontal file
105
 A periodontal file is a instrument that is used to crush or roughen a
heavy calculus deposits so that it can be removed with sickle scaler or
curette.
 The working end of periodontal file has unique charaterstic
 1)Thin and flat working end can be used to remove large deposit that
are inaccessible to the sickle scaler.
 2)The cutting edge are at 90 to 105 degree angle to the base.
 3) The base may be round and rectangular.
 4)The shank is rigid

HIRSCHFELD FILES
106
File is an instrument used to crush calculus deposits.
Hirschfeld 3/7 (facial and lingual surfaces of posterior
teeth)
5/11(proximal surface of posterior teeth)
9/10 file(facial and lingual surfaces of anterior teeth)
Orban 10/11(facial and lingual surfaces of posterior teeth)
12/13(proximal surface of posterior teeth) file.

 Diamond –coated file are instrument used for finishing of root surface.
 These files do not have cutting edges; instead, they are coated with very-
fine-grit diamond. The diamond-coated instruments from Hu-Friedy
Manufacturing Company have diamond coating placed 360° around the
tip.
 The most useful diamond files are the buccal-lingual instruments,
which are used in furcations and also adapt well to many other root
surfaces.
 Diamond files can produce a smooth, even, clean, and highly polished
root surface.
108

HOE SCALER
 Hoe scaler are used for scaling of ledges or rings
of 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 cutting edge is beveled at 45 degrees.
 The blade is slightly bowed so that it can
maintain contact at two point on a convex
surface.
109

CHISEL SCALER
The chisel scaler designed for the proximal surfaces of teeth too closely spaced to
permit the use of other scalers .
 It is usually used in the anterior part of the mouth.
It is a double ended instrument with a curved shank at one end and a straight shank at
the other .
The blade are slightly curved and have a straight cutting edge beveled at 45 degrees.
110

Implant Instruments
 To remove a tenacious calculus deposit from an implant with a graphite or
plastic instrument is extremely difficult.
 A new solid titanium implant instrument series (Brasseler USA) is available
that does not damage the implant surface, yet is able to effectively remove
the deposit .
 Hartzell and Son Co makes titanium-coated implant instruments that are
rigid and they have a stainless steel core underneath the titanium coating to
increase rigidity
111

Sharpening Eliminated
 A new technology is being manufactured to eliminate, not reduce, the
need for sharpening periodontal curette and sickle instruments.
 These instruments (XP™ Technology, American Eagle Instruments® Inc)
have gold colored working ends created by impregnating titanium nitrate
into stainless steel by surface engineering.
 Indications: Debridement, fine scaling, and root planing of nontenacious
deposits.
 Contraindications: are tenacious calculus deposits, overhang removal,
and trimming restorative margins
112

113
Oscillating
scaler
Ultrasonic sonic

 Ultrasonic and sonic instruments may be used for removing plaque,scaling,curetting
and removing stain.
Sonic unit consist of a handpiece that attaches to a compressed –air line and uses a
variety of specially designed tips.
 Vibrations in sonic tip range from 2000 to 6500 cycle per seconds .
 Sonic scaler tips are large in diameter and universal in design. A sonic scaler tip
travels in an elliptical or orbital stroke pattern.
 This stroke pattern allows the instrument to be adapted to all tooth surfaces.
 The motion of the tip of the instrument is between 0.08–0.20mm.
114

Ultrasonic
 Ultrasonic units are either manual-tuned or autotuned.
 Manual-tuned units are magnetostrictive ultrasonic devices.
 Autotuned unit there is no tuning knob to adjust the speed (frequency) of
the tip. The majority of magnetostrictive units and all piezoelectric units are
autotuned.
 Manual-tuned unit permits the clinician to adjust the frequency via the
tuning knob.
115

 Magnetostrictive ultrasonic devices work in a frequency range of 18,000 to 50,000
cycles per second.
 In a magnetostrictive unit is a core attached to the working end.
 The core is either a stack of metal strips or a ferrite rod, depending on the type of
unit.
 The handpiece is a copper wire coil that exposes the core to a varying magnetic field
when it receives an electrical current. When magnetized, the core contracts; when
demagnetized, the core returns to its original size.
116

117
 Vibrations travel from the metal stack to a connecting body that causes the
vibration of the working tip.
 Tips move in an elliptical or orbital stroke pattern. This allows the tip four
active working surfaces.

118
Beavertail Low to high Supragingival moderate to heavy
calculus, Removing stain from all
accessible tooth surfaces
Design Power setting Indication
Universal Low to high Light ,moderate and heavy calculus
removal in all areas
Probelike Low to medium Light subgingival periodontal
debridement(calculus and
plaque) ,Shallow and deep
pocket depth and furcations
Dental implants Low Debridement of dental
implants

 Piezoelectric ultrasonic units work in a frequency range of 18,000 to
50,000 cycles per second.
 They have ceramic discs that are located in the handpiece power
piezoelectric technology. They change in dimension as electrical energy
is applied to the tip.
 Piezoelectric tips move in a linear pattern, giving the tip two active
surfaces.
119

120
A Time Line for the Evolution of Powered Instruments
Date Event
Late 1950s Development of the first electronically powered instruments.
1960s and 1970s Powered instruments are used to remove heavy calculus
deposits. The bulky design of the power instrument tip limits
use to supragingival instrumentation or sites where the tissue
allows easy subgingival insertion. The Gracey curet is the
primary instrument for use within periodontal pockets.
Late 1980s Slim-diameter instrument tips are developed for electronically
powered devices.
1990s Research studies establish that bacterial products are easily
removed from the root surfaces, leading to a new approach to
instrumentation and the conservation of cementum.
Today Modern powered instrument tips have been shown to be as
effective as hand instruments for removing subgingival
calculus deposits, plaque biofilms, and bacterial products
from periodontally involved teeth.

Three modes of action
 Mechanical action, or vibration of the tip, results in deposit removal.
Mechanized instruments are said to have clinical power, referring to the
ability to remove calculus deposits under load.
 Tip action that provides clinical power is dependent on the stroke,
frequency, type of tip motion, and angulation of the motion against the
tooth surface..
 Cavitation is the action created by the formation and collapse of bubbles
in the water by high-frequency sound waves surrounding an ultrasonic tip.
Cavitation results in lavage, which is the therapeutic washing of the
pockets and root surface to remove endotoxins and loose debris.
 Acoustic microstreaming occurs because agitation in the fluids
surrounding a rapidly vibrating ultrasonic tip has the potential to destroy
or disrupt bacteria.
121

Sonic scaler
Advantages
 They create less heat at the scaling tip than an ultrasonic machine.
 Used with air pressure so no need for separate installation as in case of
ultrasonic scalers
Disadvantages
 Noisy during use
 These scalers have low range of vibraton and high tip amplitude as
compared to Ultrasonic scaler so hardly ever leads to cavitation of the
water jet.
122

Insert Design Diamond-coated inserts are available for furcations, fine scaling,
and root planing.
 Standard inserts (1 to 3 mm) are used for supragingival or
subgingival Light, moderate, or heavy calculus
 Universal inserts can be used supragingivally, primarily for initial
debridement of moderate to heavy nontenacious deposits.
 Precision thin inserts have probelike slim workingend designs
(from 0.3 to 0.6 mm wide) indicated for light-deposit periodontal
debridement in shallow and deep pockets.
 Available in three configurations—straight, right, and left
 Straight design—indicated for periodontal pockets that are 4 mm or
less
 Right and left designs—indicated to reach depths greater than 4
mm, concavities, and furcations
123

 Furcation inserts have a 0.8-mm ball-end feature,
providing more tip surface area for periodontal
debridement of furcations and root concavities
124

Ultrasonic scaler hazards
 Aerosol and splatter
 Micik and colleagues defined aerosols and splatter
 Dental aerosols are fine, airborne particles that are liquid, solid, or a
combination of both and are 50 μm or less in size.
 Spatter includes particles greater than 50 μm.
 Two type of infectious aerosols :Dust born and Droplet nuclei
 Dust born aerosols are larger in diameter and they can be easily
removed from the air by sedimentation or filtration.
 Droplet aerosols are smaller in size and settle out of the air slowly.
125

 Adverse effect of noise
The noise exposure from ultrasonic scalers commonly produced
hearing loss after long periods of time and can temporarily alter
patient hearing.
 Thermal hazards
Absorbtion of acoustic energy by the tooth surface can result in an
elevation of tooth temperature causing heat injury.
 Tactile sensitivity is impaired
 Affect on pacemakers discharge rate.
126

 Indications
 Supragingival debridement of dental calculus and extrinsic stain
 Subgingival debridement of calculus, oral biofilm, root surface constituents, and periodontal
pathogens
 Removal of orthodontic cement
 Gingival and periodontal conditions and diseases
Precautions
 Unshielded pacemakers
 Infectious diseases: human immunodeficiency virus, hepatitis, tuberculosis
 Exposed dentin (especially associated with sensitivity)
 Restorative materials (porcelain, amalgam, gold, composite)
 Titanium implant abutments unless using special insert,
 Children (primary teeth)
 Immunosuppression from disease or chemotherapy
127

Contraindications
 Chronic pulmonary disease: asthma, emphysema,
cystic fibrosis, pneumonia
 Cardiovascular disease with secondary pulmonary
disease
 Swallowing difficulty (dysphagia)
128

 One study revealed that magnetostrictive, piezoelectric, and sonic
instruments produced an equal amount of contamination that
contained bacteria as small as 0.65 μm. Despite different volumes of
coolant water, there is no difference in the amount of aerosols emitted.(
Gross KB et al. 1992.)
 Another study found that the piezoelectric unit produced the greatest
amount of contamination because of the linear motion of the tip as
compared with magnetostrictive units. (Harrel SK et al. 1998)
 A greater production of aerosols and spatter also was observed in some
of the precision thin inserts when compared with standard inserts.
129

• RUBBER CUPS:- Consist of rubber with or without webbed
configurations in the hollow interior . Used in the handpiece for
prophylaxis.
• A GOOD CLEANSING & POLISHING paste that contain fluoride should
be used & kept moist to minimize friction heat.

BRISTLE
 Available in wheel and cup shapes.
 Used in prophylaxis with a polishing paste .
DENTAL TAPE
 Dental tape with polishing paste is used for
polishing proximal surface that are inaccessible
to other polishing instruments.

AIR POWDER POLISHING
 Air-powder polishing is used with a specially designed hand piece.
 This device is called Prophy-jet. It delivers an air-powder slurry of
warm water and sodium bicarbonate for polishing.
 It is very effective for the removal of extrinsic stains and soft
deposits.
133

DENTAL ENDOSCOPE
Dental endoscope is a long, flexible tubular device that has a fiber optic light and
video camera attached.
The dental endoscope is about 1 m in length and 0.99 mm in diameter .
 The dental endoscope allows for subgingival visualization of the root surface at
magnifications of 20x to 40x .
 The endoscope is attached to a flat-screen monitor that provides a highly magnified
picture of subgingival conditions.
These has been introduced recently for use subgingivally in the diagnosis and
treatment of periodontal disease.
 This device allows clear visualization deeply into subgingival pockets and furcations.
 The dental endoscope is not recommended for routine subgingival
instrumentation because this process would be too time consuming.
134

These are classified as :
 Excisional and incisional instruments
 Surgical curettes and sickles
 Periosteal elevators
 Surgical chisels
 Surgical files
 Scissors
 Needles and Needle holders
 Bone files
136

 These include periodontal knives, interdental knives and
surgical blades.
 Gingivectomy knives Eg: Kirkland knifes
 Interdental knives Eg: Orban knife #1-2, Merrifield
knife #1,2,3 and 4
 Surgical blades Eg: 11, 12,#12D,15, and 15C
137

The kirkland knife is representative of knives typically used for gingivectomy.
These knives can be obtained as either double-ended or single-ended instruments.
The entire periphery of these kidney-shaped knives is the cutting edge .
Use for gingivectomy bevel incisions.
138

INTERDENTAL KNIVES
The orban knife#1-2 and the merrifield knife # 1,2,3 and 4 are knives used for
interdental areas.
These spear-shaped knives having cutting edges on both sides and are designed with
either double-ended or single-ended blades.
Double-ended mirror image blades on a contra-angled shank that are pointed
for access to interproximal tissue.
139
orban knife#1 (left).
orban knife#2 (right)

Pocket marker
 Pocket marker are similar in appearance to cotton plier.
 In pocket marker one tip is smooth and straight ,and the
other tip is sharp and bent at a right angle.
 The smooth tip of the pocket marker is inserted to the
base of the pocket.
 When the instrument is pressed together ,the sharp tip
makes small perforation in the gingiva ,which are
referred to as bleeding point an use to outline the area
for a gingivectomy .
140

 These are used to put incision during periodontal surgical procedures . Most
commonly used surgical blade during periodontal surgery are #12 D,15,15C.
These are mounted on bard-parker handle.
#11 Triangular blade with sharp point, flat cutting edge parallel to the handle
and flat back. And allow precise, vertical and acute angled incisions. It is useful
to drain an abscess and perform a biopsy
#12 : A small, pointed, crescent-shaped blade sharpened on the inside edge of
the curve.
142
#11 #12

# 12D blade:It is a double edged blade, beak –shaped with cutting edges
on both sides,allowing the operator to engage narrow, restricted areas with
both pushing and pulling cutting motions.
#15 blade : It has a small curved cutting edge and ideal for making
short and precise incision, Is used for thinning flap and general
purposes.
#15 C blade: This blade has a longer cutting edge than traditional
no.15 blade . used for making the initial scalloping type incision.

Bard parker handles
Bard Parker handle may be straight or contra-angle.
It is a metal instrument used to attach different type of blade. Shaft is flat with 1cm,
breadth at the middle, distal end is narrow and Proximal flat end is round.
These design help in performing procedures in different parts of oral cavity used for
cutting gingival tissue and making surgical incisions. The handle is also known as a
"B.P. handle", named after Charles Russell Bard and Morgan Parker, founders of the
Bard-Parker Company
144

 Handle #3 for use with scalpel blade #10,#11,#12 and #15
145
For palatal surgery and
other bowed blade
techniques

Periodontal surgical curette
 LUCAS SURGICAL CURETTE
 Surgical Curettes are designed for curettage,
cyst removal and tooth socket debridement
 Lucas R/L Curette, designed with a long 20mm
shank, medium 2.5mm spoon shaped blades.,
Large octagonal handle for firm control, also
available in round handle for easy rotation and
maneuvering in difficult areas.
146
2.5mm ,3mm, 3.5mm, 4.5mm
Hemingway(1/2,2/2,3/2,4/2mm)

147
MILLER SURGICAL CURETTE
Designed for curettage, cyst removal and
tooth socket debridement. Miller R/L
Curette, designed with long 23mm shanks
3.6mm wide spoon shaped blades.
PRICHARD SURGICAL CURETTE
Larger and heavier curettes for the removal
of granulation tissue and tenacious
subgingival deposits

148
Ball scaler designed for the removal of
supragingival calculus.

 Periosteal elevators used to detach the periosteum (bone covering) and gingival
tissues from around the tooth .
 These are needed to reflect and move the flap after the incision has been made for
flap surgery.
 Periosteal elevator are double –ended instrument ,one end is pointed and the other is
rounded. Pointed end ,used for elevating the interdental papilla of the gingiva and
rounded end ,elevating the mucoperiosteum from the bone .
 The Woodson and Prichard elevators are well-designed periosteal instruments.
149

Periosteal elevators
150
Prichard #3
Combines a large ,flat blade used for retraction and a
smaller curved tip used for reflection and retraction of
tissue .The Prichard Periosteal Elevator can be used as
a retractor. The larger diameter, round, lightweight,
and knurled handle make it easier to control.
Woodson periosteal elevator

151
Howarth Septum Elevator Combines a blunted end that is 4.5 mm wide with a chisel end
that is 5 mm wide.
Gargiulo #2 Combines a curved blade that is 5 mm wide and a rounded tip with a flat blade
that is 4 mm wide and a rounded tip. Both ends are sharp around the periphery
Allen #9A Combines the same tips as the traditional Molt 9 but the round end has a 3 mm
suture hole
Molt #9 Combines a large curved blade that is 7.5 mm wide and has a rounded tip with a
curved blade that is 3.5 mm wide and has a pointed tip. Both ends are non-cutting.
Goldman Fox #14 Both curved blades are 4.5 mm wide and have a rounded tip. One end is
sharpened around the periphery and the other end is non-cutting

 Tissue forceps are used to handle tissues and other materials and also to
manipulate needles and other instruments while operating.
 A variety of forceps have been developed to suit different purposes and many
of them are available in different lengths. The jaws of the forceps may be
toothed, plain or have specialised grips.
DeBakey's forceps
•Used to hold the flap during suturing
•Used to position & displace the flap after the flap
has been reflected
•DeBakey's forcep widely used in general
abdominal and vascular surgery. Designed to
grasp delicate tissues without trauma.

153
Corn Suture Pliers
Serrated blades allow
suture to pass through
the jaws
Adson toothed forcep Straight
design with 1x2 interlocking “Rat
Tooth. Fine dissectors with teeth for
gripping fine but tougher tissues.
Semkin-Taylor
forcep Curved
design with 1x2
interlocking “Rat
Tooth”
Adson-Brown Blades have 7 interlocking
teeth
Adson Tissue
Plain Forcep
useful for
grasping delicate
tissues to dissect
out nerves and
vessels.

 Chisels and hoes are used during periodontal surgery for removing and
reshaping bone.
Surgical hoe
 The hoe has a curved shank and blade, this instrument has a fish tail
shaped with blade with a pronounced convexity in its terminal portion.
 The cutting edges is beveled with a rounded edges and projects beyond the
long axis of the handle to preserve the effectiveness of the instrument when
the blade is reduced by sharpening.
154

 The surgical hoe is generally used for detaching pocket walls after the gingivectomy
incision, but it is also useful for smoothing root and bone surfaces made accessible
by any surgical procedure.
 Surgical hoe used with a pull stroke
Surgical chisels
It is a double ended instrument with a curved shank at one end and a straight shank at
the other .
The blade are slightly curved and have a straight cutting edge beveled at 45 degrees.
 The ochsenbein no 1-2 is a useful chisel with a semicircular indentation on both sides
of the shank that allow the instrument to engage around the tooth and into the
interdental area.
 Surgical chisels are engaged with a push stroke.
 The Wiedelstadt and Todd-Gilmore chisels are straight shanked. 155

156
Fedi #1 Double-ended opposing blades that are 1.75 mm wide with semi-circular
cutting edges on each side and set at a 10˚ angle.
Fedi #2 Double-ended opposing blades that are 2.5 mm wide with semi-circular
cutting edges on each side and set at a 15˚ angle.
TG Chisel Double-ended opposing blades that are 2.5 mm
wide

Surgical chisel Surgical hoe
157

Ochsenbein Chisel
 The Ochsenbein #1-2 is a useful
chisel with a semicircular
indentation on both sides of the
shank that allows the instrument
to engage around the tooth and
into the interdental area.
158

Reverse action chisel(Rhodes Chisel )
159
Designed for use with a pull
stroke, it is ideal for
removing bone adjacent to
the tooth without causing
trauma, and is especially
useful on the distal of last
molars.

Surgical files
SUGARMAN
PERIODONTAL FILE
Used interproximally. File
surfaces on both sides allow for
push or pull application.
FUNCTION: To recontour and
smooth bone in bony pockets
160

161
SCHLUGER PERIODONTAL
FILE
Used interproximally. File surfaces
on both sides allow for push or pull
application.

Scissors are used in periodontal surgery for such purposes as
1)Removing tags of tissue during gingivectomy,
2)Trimming the margins of flaps,
3)Enlarging incisions in periodontal abscesses,
4)Removing muscle attachments in mucogingival surgery.
162

163
Iris #301
Straight
blades
Iris #302
Curved
blades
Castroviejo Curved blades
with spring action
handle. Excellent for
tissue and
Suture(4’’)
LaGrange #314 A
unique curvature
allows easy
access to the tightest
areas. One
blade is serrated to
hold tissue
when cutting.

164
Suture #304
Angular
blades with
suture hook
Spencer
Suture #306
Straight
blades with
suture hook
Suture #322
Long handle,
straight blades
with
suture hook
Suture #322
Long handle,
straight blades
with suture
hook

165
•Goldman-Fox Scissor is curved with 1
serrated blade
•These scissors feature specially-
designed razor sharp upper blade edges
to cut effortlessly and cleanly through
dense or delicate tissue.
•Bottom blade has diamond-cut micro-
serrations to grip tissue and prevent
slippage
•5" in length
Goldman-Fox scissors
Super-cut Iris Curved scissors one blade are
honed/serrated to razor sharpness with
opposing blade finished with fine serration
to avoid tissue slippage. One finger ring is
gold plated for easy identification


A hemostat (also called a hemostatic clamp, arterial forceps, or pean after
Jules-Émile Péan) is a surgical tool used in many surgical procedures to
control bleeding.
The hemostat has handles that can be held in place by their locking
mechanism.
The locking mechanism is typically a series of interlocking teeth, a few on
each handle, that allow the user to adjust the clamping force of the pliers.
When locked on, the force between the tips is approximately 40 N
166

167
Mosquito Straight jaws
(120 mm).
Mosquito
Curved jaws ( 120 mm)
Kelly
Straight jaws ( 145 mm).
H103
Kelly
Curved jaws (145 mm).
Allis artery forcep

 CURVED KELLY-RANKIN HEMOSTAT:Multipurpose instrument used
to clamp off blood vessels, remove small root tips and grasp loose
objects.
168

SURGICAL NIPPERS
 To remove tissue “tags” and contour interproximal gingiva
during soft tissue surgery
 Serve same purpose as Scissors.
 They are also used for contouring the architectural form.
169GOLDMAN-FOX TISSUE NIPPER
Compact, sharp nippers with smooth action
useful for accentuating interproximal
gingival contour during soft tissue surgery.
SUGARMAN NIPRO TISSUE NIPPER

Needle point Geometry
Taper-Point
•Suited to soft tissue
•Dilates rather than cuts
Reverse
cutting
•Very sharp
•Ideal for skin
•Cuts rather than dilates
Conventional
Cutting
•Very sharp
•Cuts rather than dilates
•Creates weakness allowing suture
tearout
Taper-cutting
•Ideal in tough or calcified tissues
•Mainly used in Cardiac & Vascular
procedures.

Needle Shapes
Eye
Microsurgery
Dura
Eye
Fascia
Nerve
Muscle
Eye
Skin
Peritoneum
Cardiovascular
Oral
Pelvis
Urogenital tract
Nasal cavity
Nerve
Skin
Tendon
Eye (Anterior
segment)
Laparoscopy

173
In periodontal surgery because of the
interdental space,particularly between the
posterior teeth, long , large radius needles are
required which can easily be grasped again
after being introduced into the interdental
space on the opposite side.
Needle that 3/8 of a circle particularly suitable
for this purpose.
It is important that the needle have a triangular
cross –section. This makes it eaiser to insert
the needle and pass it through the tissue
because the needle cuts through the tissue
with its two outer cutting edge. The third
cutting is formed by the outer curvature.

NEEDLE HOLDER
Used to suture the flap at the desired position after surgical
procedure has been complete.
The castroviejo needleholder is used for delicate precise
techniques that require quick and easy release and grasp of the
suture.
174

175
Mayo-Hegar needle
holder. Large jaws
with carbide
inserts and fine
serrations
Crile-Wood
needleholder Medium
jaws with carbide
inserts and fine
serrations
Castroviejo Very fine serrations on
narrow profile jaws with carbide
inserts. The locking mechanism is
activated by squeezing the
spring-action handle. This is a
great needle holder for
periodontal applications where a
very fine suture is used

BONE FILES
 Used to remove or smooth rough edges of alveolar bone
during surgical procedures. Straight-cut bone files are
used with a pull stroke. Cross-cut bone files can be used
with a push-pull motion.
176
MILLER BONE FILE
Straight-cut bone file used for
final smoothing of bone. MILLER-COLBURN BONE FILE

The advancing abilities of instrument makers, coupled with the in-
genuity of dental practitioners, have provided the present
practitioner with a multitude of instrument designs capable of
reaching nearly every portion of the dentition.
In the past, complete sets of instruments frequently included so
many variations of angulation and were so numerous as to
preclude their general use.
177

 However, some of the more efficient instruments from
these sets have withstood the test of long-term use and
now appear and reappear in newly created instrument
sets.
178

1. Carranza’s clinical periodontology- 10 th edition
2. Principles & Fundamentals of Periodontal Instrumentation –
6th edition- Neils D. and Gehrig.
3. Textbook of dental hyginist- 3rd edition- Wilkins
4. www.google.com/images
5. www.hufriedy.com
179

Armamentarium and Advanced
Surgical Instruments
CONTENTS
 Basic surgical instrument
 Instruments for Transferring Sterile Instruments
 Instruments for Retracting Soft Tissue
 Instruments for removing bone
 Instruments for suctioning
 Photographic mirror
 Sharpening instrument
 Dental burs
 Callipers
 Instrument for implant surgery
 Instrument for Maxillary sinus floor augmentation
Indirect and direct
 Autogenous bone grafts harvesting instrument
180

181
Basic surgical
armamentarium

Dressing trolley
182
Frame and removable tray in stainless steel
Height adjustable from 90 to115cm.
Dimensions tray 70x45x2 h cm

TRAYS
183
200 x 90mm
Kidney tray
300 x 140mm
Kidney tray
300 x 200 x 50mm
Enamel tray

Drums
184
mm 190 x 160
mm 160 x 140
mm 120 x 120
mm 100 x 120

185
mm 30
mm60
mm 80
mm 45
mm 25
Cups

INSTRUMENTS FOR
TRANSFERRING STERILE
INSTRUMENTS
186

CHEATLE FORCEPS
 Long handles
 Long, angulated beaks: serrated
 Beaks: dipped in antiseptic solution
 Lift up sterile instruments from autoclave/ drum
SWAB HOLDING FORCEPS
 Long handles, straight beaks- fenestrated ends
 Rings : end of handles
 Working end- inner aspect: serrated
 Pick up sterile gauze- transfer to tray
 Hold gauze dipped in antiseptic solution- scrub the surgical field
187
INSTRUMENTS FOR TRANSFERRING STERILE
INSTRUMENTS

INSTRUMENTS FOR RETRACTING
SOFT TISSUE
188

INSTRUMENTS FOR RETRACTING SOFT TISSUE
Right angle Austin retractor
o ‘L’-shaped- no handle
o Retraction of small intraoral flaps: removal of
impacted teeth
UNIVERSITY OF MINNESOTA-
o Cheek Retractor/Tongue Depressor
189

Towel clip
o Hold the tongue
o Biopsy: performed on the posterior aspect; by holding
the anterior tongue.
Weider Retractor
o Broad
o Serrated on one side: firmly engage tongue, retract it
medially & interiorly
o Don’t position posteriorly-gagging
190

Langenback’s Retractor
o ‘L’ shaped retractor- long handle
o Retraction of flap edges : improved
visualization of deeper layers &
structures
o Different sizes: handle length &
blade width
Seldin retractor
o Similar to a periosteal elevator
o Leading edge: dull- shouldn’t
reflect periosteum
191
INSTRUMENTS FOR RETRACTING SOFT
TISSUE

Bishop cheek retractor
 Used to hold mucoperiosteal flaps, cheeks, lips
and tongue away from the surgical area.
Implantology surgical retractor
 Arched shaped retractor for retraction of the
maxillary or mandibular lips and tissue.
192

193
COLUMBIA CHEEK
RETRACTOR
OptiView
“U” type cheek
retractor
“O” type cheek retractor
-
PHOTOGRAPHIC CHEEK RETRACTOR

194
PHOTOGRAPHIC CHEEK RETRACTOR

INSTRUMENTS FOR REMOVING
BONE
Rongeur forceps
o Most commonly used
o Sharp blades- squeezed together; cutting/pinching
through bone
o Leaf spring between the handle : instrument opens
when hand pressure is released
o Repeated cuts without manually reopening

INSTRUMENTS FOR REMOVING BONE
The type of rongers selected varies with the
density of bone to be removed.the stille –lucer
is a large double –action rongers with blunted
jaws that take a 9-mm wide bite of bone.
uses
 most dentoalveolar surgical procedures
- inserted into sockets: interradicular bone
- sharp edges of bone
 Do not :
-remove large amounts of bone in single bites
- use to remove teeth

Chisel
Surgical chisel are used to remove or shape bone. They can be
used alone if the bone is soft, but if the bone is dense, a
surgical mallet is used with a chisel
o Monobevel chisel: bone is removed
o Bibevel chisel: used to split teeth
 Cylindrical handle- serrated with flat end: struck with mallet
 Single bevel- cutting edge

Osteotome
 Splitting bone
 Cylindrical handle- serrated for good grip
 Flat end- tapped with mallet
 Flat & rectangular blade
 Bibivelled cutting edge- converge to a sharp edge

Surgical Mallet
 Cutting bone with osteotome/ chisel
 Stainless steel- strong cylindrical handle
 Tapped : ‘pull-back’ action- force from wrist
 Tapped with controlled force.

BONE FILE
 Used to remove or smooth rough edges of alveolar bone
during surgical procedures. Straight-cut bone files are
used with a pull stroke. Cross-cut bone files can be used
with a push-pull motion.
201
MILLER BONE FILE
Straight-cut bone file used for
final smoothing of bone. MILLER-COLBURN BONE FILE

Bur and Handpiece
o Surgical removal of teeth
o High-speed + sharp carbide burs: for cortical bone
removal
o No. 557,703 fissure burs; No.8 round bur
o Large bone bur : acrylic bur- large bone removal

INSTRUMENTS FOR SUCTIONING
 Adequate visualization: blood, saliva, irrigating
solutions suctioned
 Surgical suction: smaller orifice than usual- rapid
evacuation of fluids
 Several designs of orifice: soft tissue not aspirated &
injured

 Frazier Suction Tip is a single-patient use surgical
instruments offer surgeons more control with a wide selection of tip
and tubing. Its malleable, aluminum-insulated shaft resists flaking
and finger cut-off control valve allow suction control. It is designed to
minimize patient trauma .
 Features
 Malleable aluminum shaft can be bent to desired position provides
flexibility during procedures.
 Available in 6FR, 8FR, 10FR, 12FR and 14FR for procedure versatility
2.0 mm internal diameter
3.0 mm internal diameter

High Volume Suction Tip
 Large bore tubes with slight angulation- end
 Autoclavable stainless steel/ plastic
 Disposable plastic tubes
 Suck out large volumes of irrigation fluids, blood clots
& debris

Saliva Ejector
 Low volume suction tip
 Disposable plastic- different designs
 Flexible- bent & adapted under tongue
 Buccal vestibule: partially retracts cheek

Sharpening instrument
 Sharpening stones, water stones are used to gride and hone the edges
of steel tools and implements.
Rationale for Sharpening
A sharp periodontal instrument:
 Enhances tactile sensitivity
 Improves quality of deposit removal
 Improves efficiency and control in deposit removal - patient comfort
 Requires less lateral pressure - less fatigue for clinician
211

Evaluation of Cutting Edges
 A dull cutting edge will reflect light.
 A sharp cutting edge will appear as a fine black line under light.
 A sharp cutting edge will “bite” into an acrylic testing stick.
Sharpening Stones type:
 Natural stones (fine - medium) - Arkansas -oil lubrication
 Synthetic stones (fine-coarse) - India and Carborundum - water
lubrication
 Ceramic stones (fine) - no lubricant needed
212

213
Arkansas fine grain, white
mm 100 x 30 x 6 x 3
India medium grain, red
mm 105 x 45 x 10 x 3
Natural stone (extra
quality fine grain)
mm 100 x 10 x 30
Fine green silicium carbide
mm 2/6 x 15 x 8 x 102
arkansas fine
ø mm 10 x 100
arkansas conical
ø mm 10 mm 100 ø mm 3

Dental burs
 Dental burs are used for cutting hard tissues - tooth or
bone. They are made of steel, stainless steel, tungsten
carbide and diamond grit
 Finishing Burs
 These heads are used for finishing restorations, soft
tissue recontouring, alveolaplasty and odontoplasty.
215

Crosscut Tapered Fissure Head
 These heads are used for sectioning multi-rooted teeth
and reducing crown height .The most useful sizes are
700/700L and 701/701L
Sharpning bur
 Mandrel Mounted Stone for the handpiece restores the
cutting edge on dull instruments. Stones are made of
white aluminum oxide.

216

Calipers
217
(Straight /Curved)
Castroviejo
180 mm
Scale 0-40 mm
155 mm
Implantology caliper
(Straight /Curved)
Castroviejo
85 mm
Scale 0-20 mm
Socket wall
caliper(0-
10mm)

 Sliding caliper
218
Right-angled calipers are ideal for
measuring bone through soft tissues

INSTRUMENT FOR IMPLANT
SURGERY
219

 Bone expander An alternative to osteotomes
 Bone expander drills for the expansion and
condensing of the atrophic mandible and
maxilla in preparation for dental implant
insertions. Expanders are also an alternative to
the maxillary sinus elevation technique.
 Expanders are driven into the bone with a
ratchet wrench or low speed hand piece. This
decreases the surgical trauma of osteotomes.
Bone expanders improve the clinical success by
improving stability, maintaining bone density
and increasing fixation.
 The Bone expander Kit includes 5 color-coded
bone expanders (2.6, 3.0, 3.4, 3.8 and 4.3mm), a
ratchet wrench, a ratchet wrench extender, a
pilot drill, a 10mm saw, a hand piece latch
adapter, and a thumb knob for finger usage. 220
Bone expanders

221
surgical guide pins are an
excellent way to avoid implant
crowding and achieve precise
paralleling
Titanium Implant Depth Gauge With Ball Tip
One side corresponds to implant lengths 6-17 mm
One side is measuring probe with 0-15 mm markings
Titanium, non-sterile

Implant hygiene and maintenace
armamentatirum
Company Product Feactures
1)Advanced Implant-prophy+ Sharpenable,autoclavable,
implant tech exceptional strength,
2)Brevet Implant cleaning kit light weight,made of
titanium alloy, sterlizable
3)Hu-friedy Implacare Disposible,high -grade
resin, mirror paired tip
4)Pro-dentec Sensor probe Thermoplastic,maintains
consistency of probing pressure
5)steri-oss Scaler system Graphid reinforced nylon
222

223
Implacare
Implant cleaning kit
Implant –prophy+
Sensor probe
Graphid reinforced

MAXILLAY SINUS FLOOR
AUGMANTATION
224

Maxillary sinus floor
augmentation
 Also termed sinus lift, sinus graft, sinus
augmentation or sinus procedure is a surgical
procedure .
 The goal of the sinus lift is to graft extra bone into
the maxillary sinus, so more bone is available to
support a dental implant.
 Lateral Window approach (opening a window in the
anterolateral sinus wall) - done by Tatum in
February, 1975
225

 Sinus Lift Curettes have spoons with smooth non-
cutting edges and are available in various shank
configurations and spoon widths to detach the delicate
sinus membrane from lateral walls.
226

Indirect sinus lift instrument
 Avalible in 2.7mm ,3.2 mm ,3.7mm, 4.2mm, and
5mm diameter.
 Marking at 6 ,8, 11,15 mm.
 Convex and concave-straight
 concave- offset
227
mm 165
mm 165

Lateral window(DIRECT SINUS LIFT)
 This technique is usually the preferred method of
sinus elevation in situations of poor bone quality and
minimal residual bone height because it allows for
direct visualization and accurate bone placement and
volume at the position of the implant. Also, tearing of
the membrane can be easily treated, minimizing
contamination of the graft during healing
228

Direct sinus lift instrument
 Sinus curette 1 (de marco curette) are
introduced along the inferior, anterior,
posterior, and superior aspects of the
prepared antrostomy window, gradually
inserting further along the bone until the
membrane begins to separate and lift away
from the bone.
 Gracy curette 13/14 are gently introduced
along the bone to continue lifting the
membrane to the desired levels (height,
width, and depth)
229

230
TARNOW-ESKOW SINUS LIFT INSTRUMENT
Used during a sinus lift procedure to separate/reflect the
Schneiderian membrane from the maxillary bone and to
elevate the membrane.
SINUS CURETTE 2
Mirror image ends with spoon-shaped tips
that are 2.7 mm wide.

231
KRAMER-
NEVINS SINUS
LIFT
INSTRUMENT,
OBTUSE ANGLES
Used during a
sinus lift procedure
to separate/reflect
the Schneiderian
membrane from
the maxillary bone
and to elevate the
membrane.
KRAMER-NEVINS SINUS LIFT
INSTRUMENT, ACUTE ANGLES
Used during a sinus lift procedure to
separate/reflect the Schneiderian
membrane from the maxillary bone and to
elevate the membrane.

Sinus Lift Balloon
 The sinus lift balloons come in 3 different configurations (straight, angled, and
micro-mini).
 while inflating the balloon with the syringe: 1cc of saline equals 6mm of
membrane elevation
 Graft material required is in direct proportion to the amount of fluid used to
inflate the balloon: 1cc of fluid will require 1cc of graft material.
 Straight model: The straight model features a 3.1mm diameter shaft and has a
4cc capacity.
 Angled Model: The angled model also has a 3.1mm shaft and 4cc capacity.
 Micro-Mini Model: The micro-mini model has a 1.9mm shaft and has a 1.5cc
capacity.
232

 Sinus Lift Balloon allows for improved vertical sinus elevation results
and gives clinicians added security when performing a traditional
lateral wall sinus lift procedure — protecting the Schneiderian
membrane from tearing, which can significantly disrupt an implant
case.
 The balloon instrument is also well-suited for effectively measuring
the required bone grafting material. For example, 1cc of saline, which
is used to inflate the balloon, is equal to 1cc of grafting material.
 The angled design is ideal for lateral window procedures.
 The straight model is well suited for a crestal approach, and the
popular micro-mini design can be used for either of these indications.
233

Water Lift System for Hydrostatic Sinus Lift
 Use the Hydro (Water) Lift system to reduce the risk of
Schneiderian membrane perforation during the sinus
membrane lifting operation. The system uses the
proven technique of hydrostatic sinus lift, to provide
evenly distributed hydraulic pressure during sinus
membrane elevation, thus ensuring the safety of the
procedure.
234

AUTOGENOUS BONE
GRAFTS HARVESTING
INSTRUMENTS
235

236
"The Osseo-Tip Bone Grafter proved to be an
effective way to harvest sufficient quantities of
autogenous bone without the need to employ a
bone mill or morselizer. It allowed for bone to be
harvested in a safe and rapid manner with no
hand fatigue.

Osseous Collectors
 It is a fast, easy, way to harvest valuable autogenous
bone that can be used to correct small defects around
dental implants and periodontal compromised teeth.
 The Osseous Collector features a unique shut-off valve
that allows to shut off the suction .
 Included with each collector are two filters.
 The unit is disposable, no cleaning is required.
237

 Bone mill
238
Bone Mill with TITANIUM teeth
Bone cracker for large bone pieces

Bone aspirators
239
Filter 7 mm
185 mm
Filter ø 12 mm
185 mm

Bone injectors and collectors
240
Bone injectors
155 mm
3,5 mm
Bone well ø 35 mm
h 35 mm
stainless steel bone funnel
measures 3.5mm in diameter and
holds approximately
1.5cc of graft material. Use with
particulate or flowable graft
material

Bone Scraper
 Osseous Glider
 The Osseous Glider is available in Straight or Angled
Versions.
 The straight Osseous Glider is recommended for the
ramus, symphasis and tuberosity areas and angled
Osseous Glider is optimized for the external oblique
ridge.
 The bone scraper enables you to scrape, collect and
transplant the patient’s own bone. The bone is
collected in a chamber during the scraping and at
the sametime the bone is being mixed with blood.
The bone material can be implanted directly out of
the bone-scraper whichhas been sterilized before.
241

Bone packer
242
5 mm - 7 mm Bone grafting packer used
during grafting procedures

Bone Trephine
 Bone trephine designed for obtaining a cylindrically
shaped core of bone that can be used for tests
and bone studies, cutting holes in bones.
243

Periodontal instruments and armamentarium with their application 245 slides

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (20)

Ähnlich wie Periodontal instruments and armamentarium with their application 245 slides

Ähnlich wie Periodontal instruments and armamentarium with their application 245 slides (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Periodontal instruments and armamentarium with their application 245 slides