Periodontal instruments

1. 1 Guided by- Presented by- DR.RUCHI BANTHIA DR.HITESH MANKAD PROFF. P.G. Student PERIODONTAL INSTRUMENTS

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

3. 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

4. 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 be scraped away. 4 INTRODUCTION

5. 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

6. 6

7. Periodontal Instruments Assessment Instruments Therapeutic Instruments Mouth mirrors, Probes, Explorers Scaler Curets Files 7 Classification Of instruments

8. 1 . Single Ended Type- 1 working end . 2. Double- Ended- May have paired or complementary working ends. 8 Based on design

9. 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. 9

10. 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. 10

11. 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. 11

12. 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 . 12

13. Periodontal Endoscope is used to visualize deeply into subgingival pockets and furcations , allowing the detection of pockets. 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 abrasive systems for tooth polishing. 13

14. As with all instruments, they have three distinct sections: handle, shank, and working end, blade or nib 14 PARTS OF INSTRUMENT

15. 15

16. The handle is that part of instrument that is held during activation of the working end . A) Types : Cone socket handles –Are separable from the shank and working end. They permit instrument exchange and replacements. Fixed : 16 Handles

17. B. Weight Hollow handles are light and are preferred to solid handles because the lighter weight enhances track sensitivity and lessens fatigue. C. Diameter – The instrument is both broad and narrow type. D. Surface Texture : Variations Instrument handles may be smooth, ribbed or knurled. For control and comfort without muscle fatigue and to prevent slippage, a smooth handle should be avoided. 17

18. The blade at the same level with the handle. Different handles, Diameter range between 5 to 10 mm 18

19. 19

20. B ased on material : Metal – Traditionally all handles are composed of stainless steel. Non- Metal – Some manufacturers offer handles composed of alternate materials in addition to stainless steel . Resin and Nylon 20

21. Rigid, Thick shank – A thick shank is stronger and is able to withstand pressure without flexing when applied during instrumentation. Strong ones are needed for removal of h eavy calculus deposits. Less Rigid, More Flexible shank- A thinner shank may provide more tactile sensitivity and is used for removal of fine deposits of calculus and for root debridement. 21 TYPES OF SHANK

22. 22 SHANK

23. 23 Straight shank Complex shank

24. 24

25. 25 PARTS OF WORKING END

26. A. Working ends- 1. Metal The type of steel used at the working end can affect the performance of the instrument . a.Stainless steel Maintains its finish without corrosion. b. Carbon steel Known for its hardness, strength and ability to hold an edge longer. 26 MATERIALS USED

27. 2. Non metal – Alternative plastic working ends are available for restorative work that cannot withstand scratching from metals, such as implant abutments. Material : - Plastic ,Nylon, Graphite Uses Probes and debriding instruments for dental implants Probes and mirrors for screening and surveys. 27

28. 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 “. 28 Mouth mirror

29. Diameter – Diameter may vary from 5/8 inches to 1 ¼ inches. In addition, special examination mirrors are available in 1 ½ to 2 inch diameters. 29

30. Attachments Mirrors may be threaded plain stem or cone socket to be joined to a handle . Because mirrors tend to become scratched, replacement of the working end is possible without purchasing new handles. Handles Thicker handles contribute to a more comfortable grasp and greater control . Wider handles are especially useful for mobility determination. 30

31. 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 . 31

32. Specific uses Indirect vision Indirect illumination Transillumination Retraction Nonspecific uses Handles can be used for Checking mobility, percussion ; 32 FUNCTIONS

33. Indirect Illumination Reflection of light from the dental overhead light to any area of the oral cavity can be accomplished by adapting the mirror . Transillumination Reflection of light through the teeth - Mirror is held to reflect light from the lingual aspect while facial surfaces to the teeth are examined to evaluate translucency of teeth. 33

34. Procedure for use – Grasp – Use modified pen grasp with finger rest on a tooth surface wherever possible to provide stability and control . 34

35. Retraction - Use a water- based lubricant on dry or cracked lips and corners of mouth. Adjust the mirror position so that the angles of the mouth are protected from undue pressure of the shank of mirror . Insert and remove mirror carefully to avoid hitting the teeth because this can be very disturbing to the patient . 35

36. Maintaining Clear vision – Warm mirror with water, rub along buccal mucosa to coat mirror with thin transparent film of saliva, and request patient to breathe through the nose to prevent condensation of moisture on the mirror. Use a detergent or other means for keeping a clear surface. Discard scratched mirrors . 36

37. Care of Mirrors – It should be examined carefully after ultrasonic cleaning or scrubbing with brush prior to sterilization to ensure removal of debris around back, shank and rim of reflecting surface . It should be handled carefully during sterilization procedures to prevent other instruments from scratching reflecting surface. 37

38. 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. 38 PERIODONTAL PROBES

39. 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. 39

40. Probe is used to A. Assess the periodontal status for preparation of a treatment plan Classify the disease as gingivitis or periodontitis by determining whether the bone loss has occurred and whether the pockets are gingival or periodontal. Determine the extent of inflammation in conjunction with overall gingival inflammation. Bleeding on probing is an early sign of inflammation in the gingiva. 40

41. B. Make a Sulcus and pocket survey Examine the shape ,topography and dimension of sulci and pockets. Measure and record probing depths. Determine the clinical attachment level . C. Make a Mucogingival Determinations Determine relationship of gingival margin, attachment level and mucogingival junction . 2. Measures width of attached gingiva 3. Roll test to locate mucogingival junction 41

42. 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. 42

43. F. Evaluate Success and completeness of treatment Evaluate post treatment tissue response to professional treatment on an intermediate, short term ,basis as well as at periodic maintenance examinations. Evaluate patients self-treatment through therapeutic disease control procedures. 43

44. Periodontal probes are classified as 1 st generation probe 2 nd generation probe 3 rd generation probe…… Pihlstrom 4 th generation probe 5 th generation probe 44 Classification

45. These include- William’s periodontal probe UNC-15 probe University of michigan O probe Marquis colour coded probe WHO probe Nabers probe 45 First generation probes

46. 46 WILLIAMS GRADUATED PERIODONTAL PROB E Markings include 1,2,3,5,7,8,9 and 10 mm with 4mm and 6mm missing for ease in measuring .

47. 47 UNIVERSITY OF MICHIGAN O PROBE WITHOUT WILLIAMS MARKING Markings are at 3, 6, and 8mm

48. 48 The UNC-15 Probe 15mm long . Markings are at each mm and color coding at the 5th,10th and 15thmm

49. 49 MARQUIS COLOUR CODED PROBE Calibrations are in 3mm sections. Markings are 3,6,9,12 mm

50. Goldman-Fox probe same as Williams probe`s calibration - But it is flattened not round 50 Goldman Fox probe

51. 51 WHO PROBE 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.

52. Types: CPITN- E (Epidemiological) CPITN- C (Clinical ) This probe was designed for Measurement of pocket depth Detection of sub gingival calculus Used in assessment of treatment needs 52

53. 53 NABER’S PROBE

54. 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 . Most of Nabers probe do not have markings. Few have markings at 3,6,9 and 12mm. 54

55. Several different companies are manufacturing plastic instruments 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 . 55 PLASTIC PROBES FOR IMPLANTS

56. 56

57. The Florida probe was developed using NIDCR(National Institute of Dental & Craniofacial Research ) criteria. This automated probe system consists of probe hand piece digital readout foot switch computer interface and computer. Its advantages are Precise Electronic measurements Computer storage data Constant probing force 57 FLORIDA PROBE

58. Disadvantages are- Lack tactile sensitivity Underestimation of deep probing depths by the automated probe. 58

59. These are pressure-sensitive probes . It has been shown that with forces upto 30 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 Vive-valley ,viva care TPS probe. 59 Second generation probes

60. These are computerized probes. Gibbes et al designed Florida probes ex- Foster miller probe , toronto automated probes which can detect cemento - enamel junction. Fourth generation These are three dimensional probes in which sequential probe positions are measured. Fifth Generation are ultrasonographic probes which provides painless probing to the patient. The guidance path is predetermined in these probes. 60 Third generation probes

61. Explorer is an assessment instrument with a flexible wire like working end. 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. . 61 EXPLORER

62. 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 . 62

63. 63 SHEPHARDS HOOK USE For supragingival examinations for dental caries and irrregular margins of restorations.

64. 64 COWHORN &PIGTAIL Used in calculus detection in normal sulci or shallow pockets extending no deeper than the cervical-third off the teeth.

65. 65 ORBAN TYPE 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 .

66. 66 11/12 EXPLORER Used for assessment of root surfaces on posterior and anterior teeth .

67. 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 . 67 SICKLE SCALER

68. 68 Blade ( working end ) (B) Tip (C) Toe (H) Heel (F) back (D) Face (G) lateral surface (E) cutting edge (internal angle )

69. Types of scalers 1 )- Different blade size. 2)- Different blade design curved, or straight . 3)- Different shank type : - Straight shanks are designed for use on anterior teeth and premolars. - Angled shanks adapt to posterior. 69

70. 70 204 S C103 CK6 Crane-Kaplan Sickle scalers angled shank, curved blade, different blade sizes

71. 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 . 71 CURETTE

72. General characteristics ( design ) : Rounded toe, no sharp points, can be inserted into deep pockets with minimal soft tissue trauma. In cross section , the blade appear semicircular ( spoon-shaped blade ) 72

73. These have cutting edge that may be inserted in most areas of the dentition by altering and adapting the finger rest, fulcrum and hand position of the adaptor. The blade size and angle and length of the shank may vary but the face of the blade of every universal curette is at 90-degree angle to the lower shank when seen in cross section from the tip . The blade of universal curette is curved in one direction from the head of the blade to the toe . 73

74. The face is at a 90-degree angle with terminal ( lower ) shank. Two cutting edge. 74

75. -Universal curettes- Columbia curettes 13-14 / 2R-2L / 4R-4L / 75

76. 76 Columbia: 2R/2L 4R/4L

77. 77 Comparision of scaler and curette

78. 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. 78 AREA SPECIFIC CURETTES

79. 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 . 79 Design of Gracey curette

80. 2 . One cutting edge. 80

81. Universal curette Gracey curette All areas and surfaces specific surfaces Area of use two cutting edge One cutting edge Use of cutting edge Curved in one plane Curved in two planes Cutting edge curvature Not Offset , 90 degrees Offset blade, 70 ْ Blade angle 81 Universal curette Gracey curette

82. 82 Rigidity type of shank

83. 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 ligual . Gracey # 11-12 : posterior teeth : mesial Gracey # 13-14 : posterior teeth : distal . 83 Double-ended Gracey curettes are 7 instruments

84. 84 Standard Gracey Curettes

85. Reduced set of Gracey 85 # 5-6 # 7-8 # 11-12 # 13-14

86. 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 mandibular molars with an intraoral finger rest. 86 Gracey #15-16

87. 87 They are modifications of the standard Gracey curette design. New features : The terminal shank is 3 mm longer ( allowing extension into deeper periodontal pockets of 5 mm or more). A thinned blade . For smoother insertion , and reduced tissue stretching. 1mm shorter blade E xtended shank instruments - After Five curette -

88. Available After Five instruments : #1-2, 3-4, 5-6, 7-8, 11-12, 13-14 Available in finishing (fine) or rigid designs: - rigid After Five Gracey curettes - finishing After Five Gracey curettes 88

89. Gracey curettes for posterior proximal surfaces mesial surfaces distal surfaces 89

90. 90

91. Rigid standard #13-14 adapted to the distal surface of the first molar. And rigid After Five #13-14 adapted to the distal surface of the second molar. Notice the extra long shank which allows deeper insertion and better access. 91

92. 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 92 Mini-bladed curettes - Mini Five-

93. Function Easier insertion and adaptation in any area where root morphology or tight tissue prevents full insertion of standard Gracey or After Five blade : 1. deep, narrow pockets, 2. furcations, 3. developmental grooves, 4. line angles, 5. Deep, tight pockets. 93

94. - Available in both: - rigid Mini Five Gracey curette finishing Mini Five Gracey curette available in all standard Gracey numbers except for the # 9-10 - A dvantages : 1. can be used easily with vertical strokes, 2. With reduced tissue distention, 3. and without tissue trauma. 94

95. The curvettes are modification of gracey curettes . These modifications include 50% shorter blade Increased blade curvature Straighter terminal shank Longer terminal shank 95 CURVETTE

96. 96

97. This set of three curette combines the shank design of the standard gracey with a universal blade honed at 90 degrees rather than offset blade of the gracey curette. This combination allows the advantage of the area-specific shank to be combined with the versatility of the universal curette blade. 97 LANGER

98. 98

99. 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 the tips 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. 99

100. 100

101. These are new type of area specific curette designed to remove light residual calculus deposits and bacterial contaminants from the entire root surfaces. These instrument are used with gentle stroke pressure with either push or pull strokes. 101 O’Hehir Curette

102. 102

103. Plastic instruments be used to avoid scratching and damage to the implants. 103 Plastic instruments for implants

104. 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 PERIOTRIEVERS

105. 105

106. 106 FILES File is an instrument used to crush calculus deposits.

107. 107

108. DIAMOND COATED FILES

109. They are also used to roughen the surface of burnished calculus deposits to facilitate removal of deposits with a curet . They can easily gouge and roughen root surfaces when used improperly. Thus not suitable for fine scaling and root planing . 109

110. 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. 110 HOE SCALER

111. 111

112. 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 . 112 CHISEL SCALER

113. 113 MECHANISED INSTRUMENTS

114. Ultrasonic and sonic instruments may be used for removing plaque,scaling,curetting and removing stain. The vibrations in ultrasonic tip range from 20000 to 45000 cycle/second. Vibrations in sonic tip range from 2000 to 6500 cycle per seconds The two types of ultrasonic units are magnetostrictive and pizeoelectric . 114

115. In magnetostrictive units the pattern of vibration of the tip is elliptic, which means that all sides of the tip are active and will work when adapted to the tooth . In piezoelectric units the pattern of vibration of the tip is linear,or back and forth, meaning the two sides of the tip are the most active. 115

116. 116

117. 117 POLISHING INSTRUMENTS

118. 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.

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

120. 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 120 AIR POWDER POLISHING

121. 121

122. DENTAL ENDOSCOPE 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 . 122

123. 123

124. These are classified as Excisional and incisional instruments Surgical curettes and sickles Periosteal elevators Surgical chisels Surgical files Scissors Needle holders 124 PERIODONTICAL SURGICAL INSTRUMENTS

125. Knives are basic instruments and can be obtained with both fixed and replaceable blades. Gingivectomy knives Eg : Kirkland knifes Interdental knives Eg : Orban knife #1-2, Merrifield knife #1,2,3 and 4 Surgical blades Eg : # 12D,15,11 and 15C 125 I ncisional & Excisiona l instruments

126. 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 . 126 PERIODONTAL KNIVES

127. The orban knife#1-2 and the merrifield knive # 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. 127 INTERDENTAL KNIVES

128. 128 GINGIVECTOMY KNIVES

129. Bard Parker handle is used for cutting gingival tissue and making surgical incisions. 129 Bard parker handles

130. Scalpel blades of different shapes and sizes are used in periodontal surgery .The most common blaes are #12 D,15,15C. The #12D blade is a beak –shaped blade with cutting edges on both sides,allowing the operator to engage narrow,restricted areas with both pushing and pulling cutting motions. 130 SURGICAL BLADES

131. Larger and heavier curettes and sickles are often needed during surgery for the removal of granulation tissue, fi­brous interdental tissues, and tenacious subgingival de­posits. The Prichard curette and the Kirkland surgical instruments are heavy curettes, whereas the Ball scaler #B2-B3 is a popular heavy sickle. The wider, heavier blades of these instruments make them suitable for surgical procedures. 132 Surgical curettes & Sickles

132. 133

133. These are needed to reflect and move the flap after the incision has been made for flap surgery. The Woodson, Glickman and P richard elevators are well-designed periosteal instruments. 134 PERIOSTEAL ELEVATORS

134. 135

135. USED TO HOLD THE FLAP DURING SUTURING USED TO POSITION & DISPLACE THE FLAP AFTER THE FLAP HAS BENN REFLECTED TISSUE FORCEPS

136. Chisels and hoes are used during periodontal surgery for removing and reshaping bone. 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. 137 Surgical Chisels and Hoes

137. Generally used for detaching pocket walls after the gingivectomy incision, but it is also useful for smoothing root surfaces made accessible by any surgical procedure . The Wiedelstadt and Todd-Gilmore chisels are straight shanked . 138

138. 139 Surgical chisel Surgical hoe

139. SUGARMAN PERIODONTAL FILE Used interproximally . File surfaces on both sides allow for push or pull application. 140 Surgical files

140. 141 SCHLUGER PERIODONTAL FILE Used interproximally . File surfaces on both sides allow for push or pull application.

141. 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. 142 Ochsenbein Chisel

142. 143 Reverse action chisel(Rhodes Chisel ) 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.

143. 144 EYELET CURETTE

144. 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 145 HEMOSTATS

145. 146

146. Scissors are used in periodontal surgery for such purposes as removing tags of tissue during gingivec­tomy, trimming the margins of flaps, enlarging incisions in periodontal abscesses, and removing muscle attachments in mucogingival surgery. 147 SURGICAL SCISSORS

147. 148 SCISSORS

148. 149 Goldman-Fox #16 scissors The Goldman-Fox #16 scissors are with a curved beveled blade with serrations and the nippers. Characteristics: 1. Long handles with thumb and finger rings. 2. Short cutting edge with straight or curved blades.

149. 150 SURGICAL NIPPERS Serve same purpose as Scissors. They are also used for contouring the architectural form and for forming interdental sluiceways.

150. Used to suture the flap at the desired position after surgical procedure has been complete. The castroviejo needleholder is used for delicate precise techinques that require quick and easy release and grasp of the suture. 151 NEEDLE HOLDER

151. 152

152. 153 Dental Surgical Burs- remove bone and section teeth.

153. Microsurgery may be defined as a refinement in operative technique by which visual acuity is improved through magnification . In addition to use of magnification & reliance on atraumatic technique microsurgery entails the use of specially constructed microsurgical instruments to minimize trauma . To permit primary woumd closure, microsutures in the range of 6-0 to9-0 are required to approximate the wound edge. 154 Micro surgical tissue pliers and forceps

154. 155

155. EVA SYSTEM It is the most efficient and least traumatic instruments for correcting overhanging or overcontoured proximal alloy and resin restorations are the motor-driven diamond files of the EVA prophylaxis instrument. These files come in symmetric pairs are made of aluminium in the shape of a wedge protruding from a shaft,one side of a wedge is diamond coated and other side is smooth . 156

156. 157

157. The advancing abilities of instrument makers, coupled with the in­genuity 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. 158 CONCLUSION

158. 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. 159

159. Carranza’s clinical periodontology- 10 th edition Principles & Fundamentals of Periodontal I nstrumentation – 6 th edition- Neils D. and Gehrig. Textbook of dental hyginist - 3 rd edition- Wilkins www.google.com/images www.hufriedy.com 160 References

160. 161