Classification of periodontal instruments

Classification of periodontal instruments

1. Good Morning To One and All 

2. Classification Of Periodontal Instruments PRESENTATION BY: Mohamed Abdul Haleem 1 st Year Perio PG KVG Dental college & Hospital, Sullia

3. CONTENTS Introduction Parts of Instruments Classification Diagnostic Periodontal probes Explorers Scaling and Curettage For supragingival scaling For subgingival scaling Cleaning and polishing Instruments Surgical Instruments Periodontal Endoscope Ultrasonic and Sonic Instruments Miscellaneous Schwartz periotreivers Plastic instruments for implants Hoe scalers Files Chisel scaler

4. Introduction Periodontal instruments are designed for specific purposes…. such as… Removing calculus Planing root surfaces Curetting the gingival wall Removing diseased tissue.

5. Parts of Instruments Periodontal instrument is composed of: Blade Shank Handle

6. Classification of Periodontal Instruments Diagnostic Periodontal probes Explorers Scaling and Curettage For supragingival scaling For subgingival scaling Cleaning and polishing Instruments Surgical Instruments Periodontal Endoscope Ultrasonic and Sonic Instruments

7. Periodontal probes A typical probe is a tapered rod-like instrument calibrated in millimeters with a blunt, rounded tip. Periodontal probes are used to locate, measure and mark pockets.

8. When measuring a pocket, the probe is inserted with a firm gentle pressure to the base of the pocket. The shank should be aligned with the long axis of the tooth.

9. Types of periodontal probes CoIor -coded Noncolor -coded The Marquis color-coded probe: The calibrations are in 3 millimeter sections

10. The UNC-15 probe: It Is a 15 mm long probe Color coding at the 5th, 10th, and 15th mm.

11. Williams probe: Has both color and non-color coding Markings at 1,2,3,5,7,8,9 and 10 mm

12. The Michigan “O” probe The Michigan “O” probe with Williams markings :At 1, 2, 3,5,7,8,9,10 mm (4 and 6 are missing) The Michigan “O” probe with markings: At 3, 6, and 8 mm.

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

14. Explorers Used to… Locate subgingival deposits in various areas Check the smoothness of the root surfaces after root planing Designed with different shapes and angles for a variety of use according to its needs.

15. Scaling and Curettage Instruments (For supragingival scaling) Sickle scalers : have a flat surface and two cutting edges that converge in a sharply-pointed tip. The arch-shape of the instrument makes the tip so strong that it will not break off during use. They appear triangular in cross-section. The sickle scaler is inserted under ledges of calculus no more than 1 mm below the gingival sulcus . It is used with a pull stroke.

16. The Morse sickle Has a very small, miniature blade Useful in the mandibular, anterior area where there is narrow, interproximal space. Sickles with straight shanks are designed for use on anterior teeth and premolars, Sickle scalers with contra-angled shanks adapt to posterior teeth.

17. Curettes (For subgingival scaling) Instrument of choice for… Removing deep subgingival calculus Removing Altered cementum Root planing Removing the soft tissue lining the periodontal pocket.

18. REMOVAL OF SOFT TISSUE LINING THE PERIODONTAL POCKET.

19. Subgingival curettes can be adapted to provide good access to deep pockets, with minimal soft tissue trauma.

20. There are cutting edges on both sides of the blade. The curved blade and rounded toe of the curette allows the blade to adapt better to the root surface. In cross- section the blade appears to be semicircular with a convex base.

21. Types of curettes There are two basic types of curettes. Universal curettes Barnhart curettes # 1-2 and 5-6 Columbia curettes # 13 -14, 2R-2L and 4R-4L Area-specific curettes Gracey curettes Double-ended Gracey curettes Extended shank curettes / After Five Curettes Mini-bladed curettes Langer and mini langer curettes

22. D ifference between Gracey and universal curettes Gracey curette Set of many curet­tes designed for specific areas and surfaces. One cutting edge used, work is done with the outer edge only Curved in 2 planes blade curves up and to the side Offset blade, face of blade beveled at 60 degrees to the shank Universal curette One curette designed for ail areas and surfaces Both cutting edges used, work is done with outer or inner edge Curved in one plane blades curves up and not to the side Not offset, face of blade beveled at 90 degrees to the shank. Area of use Cutting edge Curvature Blade angle

23. Cleaning and polishing Instruments Rubber cups: They consist of a rubber shell with or without configuration in the hollow interiors. They are used in the hand piece with a specific angle. A good cleansing and polishing paste that contains fluoride should be used.

24. Bristle brushes: Available in wheel and cup shapes Used in hand piece with a polishing paste

25. Dental tape: Used with a polishing paste for polishing proximal surfaces that are inaccessible to other polishing instruments.

26. Air powder polishing: A specially designed hand piece that delivers air powdered slurry of warm water and sodium bicarbonate. This instrument is called prophy - jet . Effective for the removal of extrinsic stains and soft deposits.

27. Contraindications: Respiratory illness Hypertension Patients on medications affecting the electrolyte balance Disadvantages: Tooth substance can be lost Damage to gingival tissue Amalgam , composite resins and cements can be roughened

28. Surgical Instruments Excisional and incisional instruments: Periodontal knives ( Gingivectomy knives); Example Kirkland knif e

29. Interdental knives: Example, Orban knife #1-2, Merrifield knife #1,2,3 and 4 Surgical blades: Example, # 12D, 15 and ISC.

30. Electrosurgery techniques and instrumentation: Electrosection used for incisions, excisions and tissue planing. Electrocoagulation , coagulation or hemorrhage control Eceltrofulguration not in general use in dentistry Electrodessication not in general use in dentistry

31. Electrofulguration , is a procedure to destroy and remove tissue (such as a malignant tumor) using a high-frequency electric current applied with a needlelike electrode

32. Electrodesiccation denatures a layer of the dermis and the curette is then used over the surgical ulcer to remove denatured dermis over the living tissue. Used in treatment of  basal cell cancers  and  squamous cell cancers  of the skin.

33. Surgical curettes and sickles : Required for removal of … Granulation tissue Fibrous interdental tissue Tenacious subgingival deposits. Examples: Kramer curettes # 1, 2, 3 and Langer curettes. Kirkland surgical instruments. Ball scaler # B 2 -B 3 .

34. Periosteal elevators : Necessary to reflect and move the flap after the incision has been made for flap surgery. Example: Goldman Fox #14.

35. Surgical chisels and hoes: Used during periodontal surgery for removing and reshaping bone . Chisels are used with a push stroke whereas surgical hoes are used with a pull stroke. Example : Rhodes chisel. Ochsenbein #1-2, chisel.

36. Surgical files: They are used primarily to smoothen rough, bony, ledges and to remove all areas of necrotic bone. Example: Schluger and Sugarman files.

37. Scissors and nippers : Used for… Removing tags of tissue during gingivectomy Trimming the margins of flaps Enlarging incisions in periodontal abscesses Removing muscle attachments in mucogingival surgery Example: Goldman - Fox # 16 scissors.

38. Needle holders: They are used to suture the flap at the desired position. Example: Castroviejo needle holder.

39. Ultrasonic and Sonic Instruments Used for removing plaque, scaling, curetting and removing stains .

40. Types of ultrasonic units Two types of ultrasonic units are there: Magnetostrictive: Vibration of the tip is elliptical. Hence all the sides can be used. Piezo-electric: Pattern of vibration of the tip is linear Only two sides of the tip are active. Ultrasonic vibrations range from 20,000 to 45,000 cycles/second . They operate In a wet field and have attached water outlets.

41. P eriodontal Endoscope It is used subgingivally …. in the diagnosis and treatment of periodontal diseases. Called as the perioscopy system . It consists of re-usable fiber optic endoscope, over which there is a sterile sheath.

42. The fiber optic endoscope fits onto the periodontal probes and ultrasonic instruments that have been designed to accept it. The sheath delivers water for irrigation that flushes the pocket while the endoscope is in use, and it keeps the field clear . This device allows clear visualization , subgingivatly , in deep pockets and in furcations . It enables the operator to detect the presence and location of subgingival deposits and guides the operator in their thorough removal. Using this device it is possible to achieve levels of root debridement and cleanliness that are much more difficult to produce without it.

43. Miscellaneous Schwartz periotreivers: Set of two double- ended, highly-magnetized instruments designed for the retrieval of broken instrument tips from the periodontal pocket.

44. Plastic instruments for implants : Rather than metal, Plastic instruments should be used… to avoid scarring and permanent damage to the implants.

45. Hoe scalers: Used for scaling ledges or rings of calculus. The blade is bent at a 99-degree angle The cutting edge is beveled at 45 degrees .

46. used in the following manner:- The blade is inserted to the base of the periodontal pocket, so that it makes a two point contact with the tooth. This stabilizes the instrument and prevents nicking of the tooth . The instrument is activated with a firm pull stroke towards the crown, with every effort being made to preserve the two point contact with the tooth. Me. Cafis Hoe scalers # 3, 4.5.6.7 and 8 are a set of six Hoe scalers designed to provide access to aLl the tooth surfaces

47. Files: They have a series of blades on a base . Their primary function is to fracture or crush tenacious calculus . Files can easily gouge and roughen root surfaces when used improperly. Therefore they are not suitable for fine scaling and root planing . They are sometimes used for removing overhanging margins of dental restorations.

48. Chisel scalers : Usually used in the too closely spaced proximal surfaces of anterior teeth It is a double-ended instrument with a curved shank at one end and a straight shank at the other. The instrument is activated with a push motion.

49. THANK YOU….