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Efficient instrumentation required

the following :

I- selection of proper instruments


for location and respective field.

II- proper instruments set-up and


arrangement on instrument
bracket-table of dental unit .
III- Correct use and picking up of all
instruments and grasping or
handling, applied required pressure
and force in proper direction and
location to avoid traumatic injury
for both tooth and other parts of
oral cavity tongue, lip, check, and
gingiva.
General classification of
operative instruments:
according to their use:
I. Cutting instruments:
Hand instruments: hatchet,
chisels, hoe, excavators , and
rotary tools and drills .
II. Condensing and packing
instruments:
Hand and mechanical
condensing and packing
instruments for applied the
restorative filling material within
the prepared cavities.
III. Plastic instruments:

Spatulas ; agate or metallic for


temporary or permanent
restorations , Carvers which used
for carving and sharpening the
filling materials, and burnishers
instruments.
IV. Finishing and polishing
instruments:
Hand: finishing strip , and
polishing points

Rotary: finishing burs, mounted


brushes, mounted stones, rubber
cups, impregnated disks and
wheels.
V. Isolation instruments:
Rubber dam & frame, holder,
forceps and punch,, cotton
rolls and , saliva ejector,
evacuating tips and
equipment.
VI. Miscellaneous instruments:

Mouth mirrors, explorers,


probes, pliers, scissors and
others.
Hand instruments are used to
assist in cavity preparation and
to insert or finish restorative
material.
They contain a handle (shaft),
a shank, and a blade which
carrying cutting edge or (also
called a nib).
Initially many types and
shapes of instruments
were used .
The metal used for
hand-cutting
instruments must be
hard and not too brittle
for cutting tooth.
ideal
metals to use are alloys of
carbon steel. The alloy used by
most manufacturers contains iron
and 0.5% to 1.5% carbon.
This carbon steel alloy is
characterized by its sharpness.
but it has disadvantage of being
susceptible to corrosion in metallic
salt solutions.
Also, careful handling is necessary
because if dropped probably fracture.
These disadvantages are tolerated
because of outstandingly sharp
cutting edge produced by alloy.
Stainless steel alloys
are also used to make hand-cutting
instruments. A common stainless steel
dental alloy contains 15% to 25%
chromium, 1% carbon, and the remainder
iron.
The chromium in the alloy reduces the
corroding tendency by depositing a small
invisible oxide layer on surface of metal.
The problem with the stainless steel
alloys is that cutting edge cannot be
resharpened to the original quality.
The problem of sharpness has resulted in
stainless steel alloys being used primarily
for working points in condensers and
instruments for inserting cement rather
than in cutting instruments. Although unit
cost of instrument is increased by the
additional alloying ,
Tarno steel, a popular
alloy in dental instruments,
is used in procedures in
which metal contacts
cement or other medicinal
products capable of
corroding carbon steel.
Another alloy often used
in instruments is stellite .
It consists of 65% to 90%
cobalt and 10% to 35%
chromium, with trace
amounts of tungsten,
molybdenum, and iron.
High resistance to acids and
hardness are its chief
characteristics.
This alloy is also used in
instruments for mixing and
inserting cements.
Parts of the hand instrument
Handle (Shaft)
component parts of hand
instrument have different shapes.
handle for developing pressures
and better grasping.
Hand instruments can have
either double or single ended
cutting edges.
Purpose of the handle is to hold
instrument and to direct the
cutting of tooth structure.

Both the number series and


manufacturer's name appear on
the handle.
Shank :

Shank connects handle with


working point and is gradually
tapered shaft down to blade or
nib. IT produces access for
cutting edge because it is
angled to offer many
approaches.
Shank may be straight or
have one, two, or three
angles; the instruments are
accordingly called straight,
monangle, binangle, triple
angle, or back-action
instruments.
The angle is regulated by
having the working point
within 3 mm. of the center
of the handle. If the
working point is not
aligned, torque develops
and results in a poorly
balanced instruments.
Blade or nib :

The blade of cutting


instruments or nib of
condensers and burnishers is
working point of instruments.
The blade is a cutting edge
that is used for cleaving and
smoothing enamel and dentin.
Some instruments are
bi-beveled and are useful
in placing undercuts in the
preparations .
nib :
Nibs are usually found on
condensers and used to impact
and adapt materials in cavity.
Working faces of nib are either
plain or serrated, depending
upon materials being used.
The serrations serve to
increase surface area of face of
nib to provide more complete
condensation and a greater
degree of density in restoration.
The serrations also help to
adapt the material to tooth
surface prior to the application
of force.
Black's instrument formula

Several numbers are engraved


within handle.

The first number is the width of


blade in tenths of millimeters,
second number is length of blade
in millimeters,
and third number is angulation
of blade with handle or shaft in
centigrade degrees ,
These instruments having only
three figures are called
conventional (ordinary) one.
Sometimes there are hand
cutting instruments having
fourth figure which present in-
between the first and second
figure which represented the
angle between the long axis of
the shaft and that of the working
part of the blade not the blade
itself in centigrade.
And this angles may be
95 or 80 centigrade for
instruments cutting at the
distal and mesial proximal
cavities respectively. These
instruments are specially
designed instruments.
How we can named the hand
instruments:
purpose of it's use -order name-
as excavator which used for
excavation purpose , scaler which
used for scaling of calculus
deposits related to tooth surfaces,
condenser which used for
condensation and packing of
restorative material into cavities
position or manner of
use - suborder name,
as gingival margin
trimmer chisels.
the form and shape of
the working part of blade
of hand instrument --
class name -- as spoon
excavator, hoe shaped,
hatchet formed, discoid
shaped.
The number of angles
added to shank of hand
instrument-- subclass --
either straight
instrument , mono-
angle, bin-angle, triple-
angle ,.etc
contra-angling of hand
instrument:
Blade or nib of instruments may be
on line with central axis of it's
shaft i.e. the straight instruments
which considered high balanced
instrument i.e. no tendency for
rotation or slipping in our hand
during function .
Working part of hand instrument may be
at an angle to central axis of shaft so , to
facilitate access to different areas of
tooth or cavities. However, this condition
will go out or throw working part of
blade out of it's central axis so, there is
tendency for slipping and rotation of
instrument during function with
tendency of traumatic injury of soft
tissues and so we must take-care.
So to prevent such
instruments imbalance
or eccentricity, such
hand instruments are
being contra-angled
Contra-angling is the additional angle
or angles which added to shank to
bring working part of blade of
instrument within 2 - 3 mm from long
axis of shaft . Number of contra-
angles can be added is depend on
length of blade and degree of original
angle or angles which being already
present at the shank
Hand cutting instruments can
be classified into an chisels and
excavators depending on their
use either for cutting and
removal of under-mind enamel ;
hardest tooth structure or to
excavate softened reduced or
demineralized carious dentin.
Chisels
straight chisels,
in which long axis of blade is in line
with long axis of shaft of the hand
instrument. No angle on it's shank .

Mono-angle chisels ,
it is similar to straight chisel, but it's
shank is supplied by one angle .
Bin-angle chisels ,

in which shank is supplied by


two angles between blade and
shaft. The beveled working part
of blade of instrument is being
found either in a mesial or distal
aspect of blade (direct cutting
instruments )
Enamel hatchet ,
cutting edge of instrument beveled
in right or left direction and bevel
is parallel to central axis of shaft.
So these cutting instruments
considered as either right or left
cutting instruments. These
instruments may be paired, one
with left and other with right
bevel, or they may be bi-beveled .
Off-angle chisels ,

which are similar to the


enamel hatchet chisels but
their working blades are
rotated by about 12.5
centigrade on the blade axis.
gingival margin trimmers

similar enamel hatchet chisels


but there is a different point that
cutting edge of working part of
blade make an acute angle with
long axis of blade. come in two
pairs, one pair for trimming of
cervical walls of mesial cavities
and other pair is used for distal
angle former chisel ,

modified form of bin-angle chisel.


The blade of angle former is
beveled on sides as well as end to
form three cutting edges forming
triple cutting edge . This
instrument is used to prepare
cavities for cohesive gold foil
restoration to establish retention.
Wedlesteadt chisels ,

looks-like straight chisels but


shank is supplied by a slightly
curvature so that blade formed
not real angle with shaft of
instrument. It is used for
removal and cleaving of under-
mind enamel and shaping of
walls of cavity.
Hoe chisels ,
which have their working blades at an
angles to their shanks . There use is
primarily to develop the internal form
of the cavities and also , used to plane ,
smooth , regulate and flattened the
enamel walls of the cavities and can be
used to remove short and loose enamel
prisms and under-mind enamel at the
cavity walls to enhance good
adaptation of restorative filling against
the cavity walls and margins.
pin angle

Mono angle chisel

Hoe chisel
A) bin angle hoe chisel , B) mon angle hoe and others (C)
off-angle enamel hatchet chisel
(special hand instrument)

gingival margin trimmer


Wards Frahms carvers
Excavators
hatchet excavators: the blades of
these instruments are equally bi-
beveled on the right and left
aspects of the blade , so the
cutting edge of the blade of the
instrument runs parallel to the
central axis of the shaft . These
instruments used to trim of the
cavity walls .
Hoe excavators:

the working part of the blade


of our instrument is looks-like
the hoe i.e. the blade is placed
at a right angle in relation to
the long axis of the shaft . It is
supplied with a bevel in a
distal direction.
Hoe excavator Hatchet excavator
spoon excavators :

in which the working part of the blade of


the instrument is looks-like the spoon
and the cutting edge is ground to a semi-
circle forming a thin edges. The blade of
these hand cutting instrument is curved
either to the right or left , so the
instrument become either left or right ,
It is very useful during peeling of the
softened carious dentin during
treatment of the deep carious cavities.
Discoid excavators :

in which the shape of the working


part of the blade is looks-like the
disc i.e. the blade have a complete
circular shape and the cutting
edges is extended all around the
whole periphery not in a semi-
circle condition as the previous
instrument .
Cleoid excavators :

a clew - like hand cutting instruments


i.e. it's working part of blade is looks-like
clew . It is a very helpful hand
instrument for removal of all soft dentin
and dentin of the pulp chamber during
endodontics. On the other hand , it is
used during carving of amalgam
restorations for creation of anatomical
landmarks of fissures and proximal
grooves and fosse and marginal ridges.
Different sizes of spoon excavators
Condensing instruments:
These are hand or mechanical
instruments used to pack or
condense restorative materials into
well prepared cavities. The
working parts of blades of
condensers is called nib, end of nib
is called face of condenser.
Designs of condensers are
generally similar to those of
cutting instruments, so, they
may be straight, mono-angle,
bin-angle, triple-angle
Nibs may have
various geometric
designs ; round
,square , Triangular ,
diamond and so on .
Face of nibs of condensers may be
smooth or serrated . Serrated one
commonly used to apply a great amount
of pressure during condensation of filling
material and increase density of material
so, increase strength properties, while
smooth one is used for increase
adaptability of filling to-ward cavity walls
and margins looks-like burnishers which
are actually act as condensers .
Nibs may have
various geometric
designs ; round
,square , Triangular ,
diamond and so on .
different tools or attachments that
are fitted in hand-piece rotated by
energy come from a source of power
looks-like electricity of dental motor
engine or a compressed air .
Usually used to remove of tooth
structures and/or restorative filling
materials ,
more-over. Cavity
margins, out-line and box
shaped are produced with
different shaped rotary
tools.
According to way and manner of
removal of tooth structure by using
rotary tools , we have

Rotary tools removed tooth


structure through actual cutting and
called burs (drills)

and tools removed tooth


structures by abrasive or abrading
action or process and called
Burs, which are considered as
a drills or cutters specially
manufactured to performed the
dental purposes.
They are supplied in different
forms , shapes and sizes
including , round or rose-head
burs , inverted cone burs and
fissure burs .
Each bur consist of shank , shaft
and head
SHANK
may be supplied with latch secure
to hand piece as in case of usual
and conventional one which are
purposed for regular and medium
speeds about 3000 - 30,000 rpm. Or
shank supplied by friction-grip
design to hand piece found in case
of high and ultra-high speed.
SHAFT
part connects head of bur to
shank. The shaft burs used in
posterior segments is short to
be used in posterior teeth .
HEAD
is that part of the bur which
carry what is called the
blades or flutes or teeth ,
the cutting part through
which the tooth structure
could be removed . The bur
head may be divided into or
supplied by 6 - 8 blades
Each blade has what is called
face and back
face is surface in front of
cutting edge and angled with
radial line of blade differently in
various burs, while other surface
of blade is called back of blade.
Angle in-between the face and
the back is called the blade angle
Angle between face of blade and
radius of bur is called Rake Angle
have a direct effect on cutting
efficiency of bur, we have positive
, zero (radial) and negative Rake
Angles depending upon whether
radial line of bur is located in
relation to face of head
If face of blade is related to or
in a direction more related to
back before radial line this is
positive Rake Angle , when face
overlying beyond radius this
mean negative Rake Angle ,
while overlying over radius
creation of zero Rake Angle.
A positive Rake Angle
enable blade of bur to cut more
effectively than zero and
negative one, but more
positively rake angle on expense
of bulk of blade i.e. blade
become more thinner cause
weaken of blade and turn down
easily and finally loss efficiency
quite rapidly .
Angle present between back of
blade and working surface of
tooth is called clearance angle
which as it is play an important
role in the reduction of friction
between tool and tooth so
decrease amount of heat which
librated or generated
Space between two successive blades
is called clearance or chip space
in which there is collection of cut chips
and then get eliminated away . if this
space is too small so, formed chips
remain in-between blades of bur and
lead to clogging of bur with loss of
efficiency and tendency for more heat
generation during cavity preparation .
according to shape and design

Rose-head burs
Are commonly used for gaining
access through enamel to dentin,
Doing starting points at point
angles of cavity as a retention
means for cohesive gold foil,
In making of retention grooves
within dentin related to line
angles of cavity
And also used for removal of
dentin roof of pulp chamber
during endodontics.
Inverted cone burs
used essentially for extension
of out-line form of cavity within
dentin i.e. they are used to cut
within dentin only.
Also, they are used to create
retentive grooves within line
angles of prepared cavity within
dentin.
Fissure burs

used for shaping , designing ,


planning and regularity of
cavity walls and margins,

obtaining the required


retention &resistance form
and during finishing step of
cavity preparation.
Also, used for obtaining
retentive grooves within
dentinal line angles e.g. to
obtain proximal - axial grooves
within proximo-buccal and
lingual line angles of proximal
box in case of compound class
ll cavities.
We have many shapes of
fissure burs , tapered
fissure burs, cylinder type ,
end cutting fissure burs
which are used for
extending and flattening of
gingival walls.
According to design of
fissure bur , we have the
plane fissure burs in
which blades either
present in straight
manner or in a spiral one .
AND
cross-cut fissure burs in
which planed of flutes or
blades in a straight or in
spiral manner were cross-
cutted to increase number of
flutes used during cutting
so , increase cutting
efficiency of tool.
plain type straight fissure bur

cross-cut straight
fissure bur

short tapered cross-cut


fissure & long tapered
According to purpose of use:
As we have tools or burs used
for cutting purposes,
finishing and polishing burs ,
supplied in different shapes and
sizes and used for finishing and
polishing of the restorations
and the cavity walls and
margins.
The differences between them ,
@ finishing &polishing tools
had more blades than
6 - 8 blades
@ more radial or negative
rake angle ,
@ more thick of the blade size
@ small clearance or chip
spaces
@ and the blades are shorter in
length than the cutting burs .
we must keep in mind that
only way by which there is
increasing cutting efficiency
of bur by increasing the
number of blades of head of
bur is through cross-cutting
technique of blades .
according to material
from which bur is made

Two types of burs


stainless steel burs,
and tungsten
carbide .
(A) Carbide burs are quite more
efficient and have more longer
life span than steel burs .

(b) they are less heat generation


specially during using high
speed with a copious amount
of water as a coolant
(c) steel burs are used only at
low speed 3000 -10,000
over that speed there is
tendency for dulling or turn
up of the bur
(d) the carbide burs are quite
and precisely manufactured
more than the steel one ,

(e) but they are much more


expensive and brittle if they
are suddenly dropped on the
ground
(f) Carbide burs are quite
cutters in the clock-wise
direction only while steel
one quite cutters in both
directions clock and anti-
clock-wise directions .
(g) Carbide burs are superior over steel
and not subject to dulling due to:

@ carbide burs have a higher Vicker's


hardness number about 1700 so the
blades will resist the fracture or bending
or turn-down , as compared to the steel
which have V.H.N. 600 -700.
@ carbide burs have a higher melting
point than steel so can withstand the
heat generation without dulling when
compared to the steel .
this is the maximum lateral
displacement of the peripheries
of the working part of the head
of bur or tool from its central
axis. A bur or a stone is said to
be eccentric if this lateral
displacement is more
than 0.025 of a mm.
Eccentricity lead to vibration of the bur
loss of efficiency,
generation of much heat.
operator will lose tactile sense, and
thus becomes less able to control
instrument.
lead to sever pain and discomfort for
patient
cracking and fissuring enamel and
tooth.
Vibration or run-out lead
to rebound phenomena
which character by
edema, fibrosis of pulp
tissues and change
ground substances and
degeneration and
necrosis.
Eccentricity may also
result from loss of
precision of the hand
piece, engine attachments
and bullies.
Power Sources.
The removal of tooth
structure can be
effected using any of
the following sources
of power:
The Airbrasive.
Here, tooth structure is
removed by means of particles
of aluminum oxide (abrasive )
moved into it at great velocity
by means of a high pressure
gas stream (CO2) and directed
at a definite angle.
The Ultrasonic.
In this technique, the tooth
structure is removed by means of
tips of various sizes and shapes
which vibrate at high frequency
(29,000 cycles per second)
against a slurry of abrasive,
usually aluminum oxide, in
contact with the tooth to be
operated upon.
Rotary Equipments.

These are essentially classified into


equipments employed at conventional
speed ranges (from zero to 45,000
rpm.), and those employed at
accelerated (high) speed ranges of
above 100,000 rpm. The conventional
speed ranges may be further classified
into low, i.e., 3000-6000 rpm. medium-
high of 10,000-20,000 rpm., and high
speed ranges of 20,000-45,000 rpm.
Heat generation

during removal of tooth


structures by rotary
instruments, heat will
generated due to actual
friction between tool and
tooth
Friction depend greatly upon
1) amount of pressure applied,
2) size of bur or tool
3) range of speed ,
4) type of bur rose head or
inverted or fissure ,
5) dull or inefficient bur and
6) time of contact between tool
and tooth surface .
So that , greater the amount of
pressure applied lead to more
friction and heat generation ,

larger size of bur lead to more


heat generation due to increase
friction ,

using high and ultra-high speed


more heat generation
fissure bur created more heat
generation than inverted and
rose head burs due.

using of dull bur need more


pressure during cutting which
lead to more friction and high
heat generation ,
also , longer the time the
rotary tool remain in contact
with tooth , more the
amount of heat generation .
Frictional heat generated during
procedures will be go through :
1- tool or bur

2- surrounding atmosphere

3- formed cutted chips of E&D

4- dentin of tooth
(through tooth).
amount of heat dissipated
through tooth is most
important review.
Furthermore, atmosphere
surrounding working tool
furnishes most important
medium for control of such an
amount of heat reaching vital
tooth tissues, dentin and pulp
Dentin is an excellent
thermal insulator with a
thermal tolerance of
58 to 130 F that is to say, it
can protect the pulp against
temperatures between
these extremes.
But beyond these extremes, it
retains heat with consequent
pain and pathologic changes in
pulp.
For this reason, it is essential
that a type of coolant be used
either air or water or both
which is preferable one and
more effective
The coolant serves to:

1-control the temperature at


surface of tooth and to keep it
within thermal tolerance zone
of dentin.
Therefore, the temperature of
coolant must be close to that of
the body.
2-Keep the working field clean
and thus improve visibility and
workability

3-Clean the tool and


prevent clogging with debris
and loss of efficiency.
The life of the tool will thus be
extended .
4-Lubricate the tooth
surface and hence make
the cutting easier and
more rapid.
5-Decrease the need for local
anesthesia. This allows the
pulp to respond to operative
trauma under a natural
condition, i.e., without
vasoconstriction.
For a coolant to be
efficient, it should be used
in adequate quantities and
be directed in such a way
that it covers the entire
surface of the working tool.
Cutting efficiency of the bur:
which can be defined as ability of
tool or bur to remove and cutting
a maximum amount of tooth
tissues with a minimum of effort
and time involved.
This cutting efficiency procedure
is really influenced by several
factors as design of bur ,
composition of the bur and tissues
to be cut.
Design of bur :
More positive rake angle of blade
of bur, the more thinner of
blades or flutes, more effective
during cutting but there is shorter
of life span of bur .

On contrary, negative and zero or


radial rake angles make bur not
effective during cutting.
the number of blades or flutes
or teeth of the head of bur
bur with a cross cutting blades
has a greater cutting efficiency
than conventional plane cut bur.
the suitable number supplied to
head of bur is 6 - 8 blades not
more
presence of clearance spaces and
not reduced in numbers or in size
is very important variable affected
cutting efficiency of bur , because
reduction in number and size of
clearance spaces lead to increase
tendency of clogging of bur,
increase tendency of more heat
generation and finally reduction of
the cutting efficiency of the bur
When cutting the tooth
structures , the dentist try to
applied a certain amount of
force on the tooth:

P= ___F____
A
This pressure when exerted
increase cutting rate of bur, lead to
the following :
1 - increase heat generation during
preparation of cavities .

2 - increase dulling tendency of bur


with decreasing life span of bur
with direct reduction effect on
cutting efficiency.
round bur is most efficient end
cutting tool and therefore used
for gaining access through
enamel to dentin by contact a
wide surface area and using a
less stresses induced in bur with
less amount of heat generation
due to less induced pressure .
ability of inverted cone bur to remove
tooth structure ( dentin ) per unite of
time is to be five times of fissure bur
and at the same time surface area of
fissure is about three times of that of
inverted cone bur , so inverted cone
bur is quite efficient 5 x 3 = 15 times
for removal of tooth structure (dentin )
than fissure bur which is commonly
used for extension of the out-line form
of the prepared cavity .
presence of the clearance angle
which considered important to be
found due to it will prevent nearly
contact of back of blades of bur to
cutting surface so avoid rubbing
action instead of cutting action
and further more reduce heat
generation i.e. presence of
clearance angle lead to maintain
and increase cutting efficiency.
Composition of bur:
we have two types of burs stainless steel
and carbide tungsten, and carbide burs are
much more efficient than steel one.
Carbide burs cut in both in enamel and
dentin quite effectively, and their cutting
efficiency will be increased as rotational
speed is increased. On the other hand steel
burs are more effective in cutting of dentin
than enamel and only at low speed ranges
not at high speed other wise edges of
blades of steel bur will soon turn-down. This
is due to the following :
@ the lower hardness number and strength of steel
burs which readily lead to loss of sharpness of blades
which lead to generation of more heat during cutting
and removal of the tooth structures.
@ At high speed ranges , there is tendency for
generation of more heat due to the friction between
the bur and tooth structure , as the steel bur posses
the lower melting point in comparison to the tungsten
carbide one which causes the blades of the bur to
soften and bend more under the effect of the heat
generated .
@ The carbide burs are much precisely manufactured
and this has a positive effect to increase the cutting
efficiency in comparing to the steel burs.
The previous factors act surely to decrease the
cutting efficiency of the steel burs and their life span .
Tissues to be cut by the bur:
enamel considered a hardest tooth
structure than dentin or
cementum (about 300 psi ) and
posses a highly resistant to
cutting with burs. Dentin is softer
(about 60 psi ) and easier to cut.
If for any reason steel bur used to
cut within enamel it will be dulled
out quickly.
Abrasives , which are tools used to
remove the tooth structures
enamel and dentin not by actual
cutting but by abrasion manner .

Abrasives like diamond ,


carborundum , and sand may
be made into different sizes ,
shapes.
Abrasives cut more efficient in
enamel than dentin. On the other
hand due to diamond stone or
points have a greater hardness
Vicker's number about
7000 - 8000 Psi, it is quite more
efficient on removal enamel than
carbide burs.
Mainly , abrasives classified into
1) stones 2) discs
abrasive particles either diamond or
carborundum or sand particles are held
together by means of binder material which
may be ceramic binder particularly for
binding diamond chips in case of the diamond
points and stones, or metallic binder
material through electroplating process, and
previous binder are used for hard grade
abrasive tools i.e. points or tools used to
remove tooth structures, while for soft grade
one which used for finishing and polishing
procedures, rubber or shellac binder material
is used when delicate abrasion required .
different types according to shapes and purpose of use of diamond stones

different shapes & sizes and lengths of diamond abrasive stones


different shapes of carborundum stones for different purposes
for both B) contra-angle and A) straight hand pieces