Professional Documents
Culture Documents
Operative Dentistry
CARBON STEEL:
HARDER THAN STAINLESS STEEL
MAINTAINED BETTER SHARPNESS
CORRODE IN MOIST CONDITIONS
Carbon steel
Stainless Steel
Preferred materials
Remains bright under most conditions
Loses keen edge during use much more
quickly
Chromium: corrosion resistance
Carbon: hardness
Stainless Steel
TUNGSTEN CARBIDE
Amalgam explorers,
excavators chisels others mirrors others
condenser probes
ordinary
straight files
hatchets
Angle
bin-angle carvers
formers
Enamel
spoons
hatchet
Gingival
margin trimmers
According to G. V. Black
ORDER
PURPOSE OF THE INSTRUMENT
E.G. EXCAVATOR, SCALER
SUB-ORDER
MANNER OF USE
E.G. PUSH, PULL
CLASS
FORM OF BLADE
E.G. HATCHET, CHISEL
ANGLE
NUMBER OF ANGLES IN THE SHANK: MONOANGLE, BIANGLE,
TRIPLE-ANGLE, QUADRANGLE
E.G. BIANGLED HATCHET EXCAVATOR,
Classification of Instruments:- by Charbeneau
Cutting instruments
Hand- hoes, chiesel etc
Rotary- burs, discs etc
Condensing instruments
Pluggers
Plastic instruments
Carvers, Burnishers
Finishing and polishing instruments
Discs, Strips
Isolation instruments
Cotton roll, Rubber dam
Miscellaneous-
Mirrors, Explorers
CLASSIFICATION BY MARZOUK
85
Bevels
Most hand cutting instruments have on the end of the
blade a single bevel that forms the primary cutting edge.
Additional two secondary cutting edges that extend from
the primary cutting edge for the length of the blade.
Allows cutting in 3 directions; facial and lingual walls of
the proximal cavity
Bibeveled instrument have two bevels that form
the cutting edge;
e.g. hatched excavator
Single beveled instrument such as spoon
excavator and gingival margin trimmer are
used with lateral cutting movement.
Enamel hatchet also as a single beveled instrument
Excavators Chisels
Spoon excavators
discoid cleoid
triple-
angled
spoon
Cleoid spoon
Discoid spoon
Discoid is disc shaped, with cutting edge around the blade
Chisels:
Enamel Hatchets
(12-7-0)
The shank and blade of the chisel also may be
slightly curved (Wedelstaedt design)
11½-15-3
Biangled chisel
Force used with chisels : straight thrust
10-7-14
Gingival margin trimmer
Blade is curved
Bevel for cutting edge: outside of the curve
Face of instrument: inside of the curve
Mesial Distal
12½-75-7-14 12½-100-7-14
Cutting edge angle: 100 and 75 :
Amalgam preparations.
Uses:
occlusal preparations.
Horizontal strokes:
Pulling stroke
Pushing stroke
1. Loss of control.
2. More pain.
3. Prolonged time for the operative procedure.
4. Reduce the quality and precision of tooth
preparation.
Stationary sharpening stone e.g. Arkansas
stone, silicon carbide.
Mechanical sharpener; moves at low speed while
the instrument is held at the opposite angle and
supported by a rest i.e. easier and less time
consuming.
E.g. Rx Honing Machine
Mechanical sharpener
Principles of Sharpening
Sharpen instruments only after they have been cleaned
& sterilized
Establish the proper bevel angle (usually 45 degree)
and the desired angle of the cutting edge to the blade.
Use light stroke pressure
A B
C
Explorers
To feel tooth surface for irregularities
To determine the hardness of exposed dentin
1. Shepherd’s hook: No. 23
2. Cowhorn explorer: No. 2
3. No. 17: back action
Tweezer/ cotton forceps:
Cotton forceps are used for picking up small items,
cotton pellets
Plastic filling Instruments
restoration.
the prepared cavity to narrow the gap between gold and the
tooth.
Burnishers
Disposable brush
Scissors
Used for cutting dental dam material, retraction cord,
and stainless steel crowns.
Crown and bridge scissors
Dappen Dish
Hold certain liquid dental materials during a procedure.
Howe Pliers
Also referred to as 110 pliers. Useful for holding items, for
Guards
Interproximal wedges to protect soft tissues from contact
Modified pen.
Inverted pen.
SPEED
SURFACE FEET PER UNIT TIME OF CONTACT THAT THE TOOL
HAS WITH THE WORK TO BE CUT OR REVOLUTIONS PER
MINUTE
ACCORDING TO MARZOUK:
1. ULTRA LOW SPEED: 300-3000 RPM
2. LOW SPEED: 3000-6000 RPM
3. MEDIUM HIGH SPEED 20,000-45,000 RPM
4. HIGH SPEED 45,000-1,00,000 RPM
5. ULTRA HIGH SPEED > 1,00,000 RPM
According to Charbenau:
1. Conventional or low speed: below 10,000 RPM
2. Increased or high speed: 10,000-1,50,000 RPM
3. Ultraspeed: above 1,50,000 RPM
According to Sturdevant:
1. Low or slow speeds: below 12,000 RPM
2. Medium/Intermediate speeds: 12,000 to 2,00,000
RPM
3. High/ Ultrahigh speeds: above 2,00,000 RPM
Pressure:
P=F/A
Low speed: 2-5 pounds of force
High speed: 1 pound of force
Ultra high speed: 1-4 ounces of force
Heat Production
Directly proportional to the Pressure, RPM, and
area of tooth in contact
113˚ F : Pulpitis & pulp necrosis.
130˚ F : Permanent damage of pulps.
Brown et al: Temperature of dentin at a distance of
0.5 mm from a high speed bur cutting dry to be
245˚F (118˚C).
Optic
TORQUE:
ABILITY OF THE HAND PIECE TO WITHSTAND LATERAL
PRESSURE ON THE REVOLVING TOOL WITHOUT DECREASING
ITS SPEED OR REDUCING ITS CUTTING EFFICIENCY.
Friction:
Through the centrifugal force and The pressurized air in the ASBD is
rotation of the impeller, air continues released to the outside at the
to flow into the ASBD and remains bottom of the head
pressurized even after drive air is
stopped.
Low-Speed Handpiece
Design
Straight in appearance.
Standard length and “short.”
Speed ranges from 10,000 to 30,000 rotations
per minute (rpm).
Operates the rotary instrument in either a
forward or backward movement.
Uses of the low-speed handpiece
Intraoral
Removal of soft decay and fine finishing of a
cavity preparation.
Finishing and polishing of restorations.
Coronal polishing and removal of stains.
Extraoral
Trimming and contouring temporary crowns.
Trimming and relining of removable partials and
dentures.
Trimming and contouring of orthodontic
appliances.
Low-Speed Attachments
Two types
Removes decay.
Removes an old or faulty restoration.
Reduces the crown portion of the tooth for the
preparation of a crown or bridge.
Prepares the outline and retention grooves for a new
restoration.
Finishes or polishes a restoration.
Sections a tooth during a surgery.
Ultrasonic Handpiece
Design
Attached to the dental unit.
Powered by electricity.
Attachments are similar in appearance to scaling
instruments.
Delivers a pulsating spray of water.
Uses of the ultrasonic handpiece
Removes calculus.
Removes stain.
Removes bonding materials from a tooth surface
after orthodontic appliances are removed.
Removes cement after orthodontic bands are
removed.
Laser Handpiece
Design
Advantages:
Usually painless.
Patient usually does not require anesthesia.
Proceed with procedure faster.
Disadvantage:
Cannot be used on teeth with existing restorations.
AIR-ABRASION HANDPIECE
Design
Endodontic access.
Crown margins.
Cutting Abrasive
Carbide burs
1- Diamond burs
2- Discs
Made from 3- Stones
1- tungsten carbide 4- Rubber wheels
2- steel carbide
According to composition:
1. Steel burs
2. Tungsten Carbide burs
Steel burs cut human dentin at low speeds, but dulls rapidly at
higher speeds or when cutting enamel
Regular –cut
Coarse-cut
Twelve-fluted carbide bur
Its used for highly smoothing of prepared surfaces of tooth
Groove seating
Bur numbering systems
So no. 57 ,557 and 957 are all had the same head size
Iso system(international standard organization)
FDI (Federation dentaire internationale)
Round
Bur size: 1/16 1/8 ¼ ½ 1 2 3 4 5 6 7 8 9 11
Diameter: 0.30 0.40 .50 .60 .80 1.0 1.2 1.4 1.6 1.8 2.1 2.3 2.5 3.1
Inverted cone
Bur size: 33½ 34 35 36 37 39 40
Diameter (mm): .6 .8 1.0 1.2 1.4 1.8 2.1
Straight Fissure:
Bur size: 55½ 56 57 58 59 60
Diameter (mm): .60 .80 1.0 1.2 1.4 1.6
Straight fissure, round end:
Bur size: 1156 1157 1158
Diameter (mm): .80 1.0 1.2
Tapered fissure:
Bur size: 168 169 170 171
Diameter (mm): .80 .90 1.0 1.2
Tapered fissure, rounded end
Bur size: 1169 1170 1171
Diameter (mm): .90 1.0 1.2
Pear:
Bur size: 329 330 331 332
Diameter (mm): .60 .80 1.0 1.2
Long inverted cone, rounded corners (amalgam preparation)
Bur size: 245 246
Diameter (mm): .80 1.2
End-cutting:
Bur size: 956 957
Diameter (mm): .80 1.0
Bur head design:
Runout:
Test measuring the accuracy with which all blade tips
pass through a single point when the instrument is
rotated.
Radial rake angle: radial line & the tooth face coincide.
Angle between the back of the blade and the tooth surface.
1. Primary clearance angle: the angle the land will make with work.
2. Secondary clearance angle: the angle between the back of the bur
tooth and work.
3. Radial clearance angle: is formed when the back surface of the bur
tooth is curved.
Provides clearance between the work & the cutting edge to prevent
the tooth back from rubbing on the work.
Abrasive instruments
Head consists of small angular particles of hard substance
embedded in a soft binder (ceramic, metal, shellac,
rubber).
Diamond abrasives
Medium grit
Fine grit
Diamond instruments consists of three parts:
A metal blank,
The powdered diamond abrasive
A metallic bonding material that holds the
diamond powder onto the blank
TF: Taper flat end; TR: Taper round end; TC: Taper conical
end; FO: Flame Ogival end; SF: Straight flat end; SO:
Straight Ogival end; BR: Ball round; WR: wheel round edge;
Discs, Mandrel, Stones, and Wheels
Moulded abrasive instrument –
Manufactured by pressing a uniform mixture of abrasive
and matrix around roughened end of shank,
Points and stones; finishing & polishing
Its hardness is less than healthy dentine while harder than the
carious dentin.
Ability to self-limit(selectively)
It will only cut what is carious and if it’s in contact with
healthy dentin the bur will only wear away (when extensive
force isn’t used).
Advantages:
Conservative
Minimal to none disease transfer (because its single
use only).
No need for Local Anesthesia.
For Students to start with first clinical cases.
Disadvantages:
Single-patient-use = Expensive.
Abrasive Cutting:
Diamonds are most efficient when used to cut
brittle materials, are superior to burs for removal of
the dental enamel.
Burs are generally preferred for cutting ductile
materials such as dentin.
CUTTING RECOMMENDATIONS
Recall:
Wait for the instrument to stop or extremely careful while removing the
handpiece from the mouth.
Large disc
Hand excavators: soft caries removal in the deep preparation may lead
to mechanical pulp exposure: round bur at low speed.
Eye Precautions
Airborne particles, old restorations, tooth structure,
bacteria, debris.
Strong high volume evacuation.
Ear Precautions:
Loud noise: mental and physical distress, increase accident
proneness, reduce overall eficiency.