Introduction to the Instruments:

Basic Set:
● XAE11/12 = Explorer
● PACP12 = Perio Probe
● PA2N Nabor Probe (looks like a very thin sickle)

Graceys: the more posterior, the more bent looking! Always remember … “V to the D”
● 5/6 = ALL Surfaces of anterior teeth – terminal shank is straight
● 7/8 = buccal/lingual surfaces of posterior teeth– terminal shank is straight (house)
● 11/12 = Mesial – subtle bending
● 13/14 = Distal
● 15/16 = Mesial – more posterior = more crazy bend of terminal shank
● 17/18 = Distal – scary looking

This image is comparing the 5/6 (top) This image is comparing 11/12 (left) to 15/16 (right)
to the 7/8 (bottom) note that the 15/16 shank is more bent/funky looking

Gracey Sickles:
● SA6/7SS= Anterior Sickle Scaler

Universal Curettes/Gracey
● SA4L/4RSS = crazy house looking one with curved terminal shank, rounded toe, blade is 90
degrees = NOT offset
● SA0/00SS = completely straight shank
● SASUBOSS = Subzero curette = straight terminal shank, tiny working end (looks like a hook)

Lecture 1:
● Neutral position:
o Trunk and head straight
o Forearms and hands parallel to the floor
o Weight evenly balanced
o Thighs are almost parallel to the floor, but hip is higher than knee
o Legs in a V-formation
● Right handed operator position:
o Front: 8 to 9
 o Middle: 10 to 11
o Back: 12 to 2
● Maxilla positioning:
o Patient is supine
o Maxillary occlusal plane is perpendicular to the floor
o Neck extended as much as possible
o Light directed from a 45 degree angle above chest

● Mandible positioning:
o Patient is semi-supine and patient’s chin is down
o Patient can be slightly elevated (20 degree)
o Light is directing from straight above the mandible
o Occlusal plane is almost parallel to the floor
● Remember that the patient’s head is moveable!!

● Modified pen grasp: most efficient grasp, enables you to control stability and gives you a pivot
point
o Thumb and index finger opposite at junction of handle and shank
o Handle is between junction of the first and second joint of the index finger
o Pad of middle finger is against the shank (side of pad)
o Fingers are as a unit
● Fulcrum = finger rest
o Allows for stability and power
o Controls stroke
o Conventional = intraoral - should be as close to working area as possible (approximately
2 teeth away)
▪ Finger on finger
▪ Occlusal plane
o Extra-oral
▪ Patient’s chin
▪ Patient’s zygoma
o Palm-up, palm-down
o Do NOT fulcrum on the same tooth you are working on!
● Wrist activation = lower and raise wrist!
● Strokes:
o Should be short and overlapping
o Stay in the sulcus
o Go to the depth of the sulcus/pocket
o Apply lateral pressure
o Controlled
 ● Adaptation: the working end of the instrument should stay against the tooth
o Working end = toe/tip 1/3
o Rotate to contour of tooth surface
o Rotate/pivot on the fulcrum point
o Rotate into the proximal surface
o Keep lower shank parallel to the tooth surface
● Angulation: want the face of the blade closed against
the tooth
o Working stroke = 45-90 degrees ➔facilitates
ideal calculus removal
o Angulate by tilting and rotating the wrist

Lecture #2: Sickle Scaler and Area Specific Curettes = Anterior Scaling
● Sickle scaler:
o Straight rigid shank
o 2 cutting edges! – Straight or slightly curved
o Back of the instrument is pointed or rounded
o Used for supragingival calculus removal and stain
▪ Can be used slightly subgingival (1-2 mm)
as long as the tip is well adapted to the
tooth surface
o Offset side is to be used for scaling!
o Handle should extend parallel to long axis of teeth when interproximal
o Use a vertical stroke (up and down)
● Introduction to the Gracey Series:
o Anterior teeth:
▪ 5/6 = ALL surfaces of anterior teeth and premolars
o Posterior teeth:
▪ 7/8 = Buccal and lingual surfaces of posterior teeth
▪ 11/12 = Mesial surfaces
▪ 13/14 = Distal surfaces
▪ 15/16 = Mesial surfaces
▪ 17/18 = Distal surfaces
● Working end is tilted in relationship to the terminal shank = offset by 70 degrees
o One cutting edge is lower than the other
o Lower end is the one that is used for
instrumentation (lower blade = cutting edge)
o Allows insertion into deep pockets
o Prevents tissue trauma
o Easier adaptation
o Correct cutting edge to tooth surface angulation
 o Lower shank will be parallel to the surface being scaled
o Lower 1/3rd (toe) is used for calculus removal
● Gracey 5/6:
o Used to scale ALL surfaces of anterior teeth!
o Initiate stroke at the midline towards interproximal
o Adapt the blade to the surface being scaled
● Surfaces TOWARD (facial aspect) = mandible (#22-27)
o Knees together (ONLY for this area)
o Sit to the side and face your patient
o Front position = 8-9 o’clock
o Activation of working stroke from midline of the tooth working in a
direction toward you (the operator)
● Surfaces AWAY (facial aspect) = mandible
o Knees apart
o Sit at the 12 o’clock position
o Activation of working stroke at midline of tooth toward non-dominant side
● Surfaces TOWARD and AWAY = maxilla
o For the maxilla you are at 12 o’clock for BOTH towards and away
o Toward = activation of working stroke from non-dominant side toward dominant side
o Away = activation of working stroke from dominant side toward non-dominant side

Week 2: Lecture 3 – Area Specific Curettes

Exploratory Stroke Working Stroke

- Blade is less than 45 degrees
- Grip is lighter
- Tactile sensitivity is enhanced
- On the “down stroke”
- Objective: identify depth of calculus
- Blade is 45-90 degrees
- Firm grasp
- Engage blade by adaptation
- On the “up stroke” = vertical or oblique
strokes
- Objective: calculus removal

● Extra-oral fulcrum: stabilization of the clinician’s hand outside the

patient’s mouth
o On the cheek, chin, or zygoma
o For dominant side = place back surface of the 4th finger on the face
(palm up)
o For non-dominant side = place the inner surface of the 4th finger on
the face (palm down)
● 7/8 Gracey Curette:
o For buccal and lingual surfaces of
posterior teeth
o Initiate stroke from distal line angle
o Finish stroke at the mesial line angle
o Stroke = oblique or horizontal
o Stroke is towards the midline (distal to mesial)
● 11/12 and 15/16 Gracey Curettes:
o Used on mesial surfaces of all posterior teeth
o Initiate stroke at mesial line angle and continual towards mesial-interproximal surface
o 11/12 = useful for premolars
o 15/16 = useful on molars
o Larger number/more gnarly bend = used on MORE POSTERIOR teeth
 ● 13/14 Gracey Curette:
o Used on distal surfaces of all posterior teeth
o Initiate stroke at the distal line angle and continue towards distal interproximal
o Keep lower shank parallel to the surface scaled

Week 2: Lecture 4 – Universal Curettes

● Can adapt to ALL tooth surfaces! Can be used on anterior and posterior teeth
● Rounded toe
● 90 degree blade angulations = blade is NOT offset
● 2 blades = 2 cutting edges
● Shank curvature allows adaptation
● Both blades are used! = Primary and secondary
blade
● Universal in our kit = Columbia 4R/4L
● Both working ends of instrument will be used!
o For anterior teeth you need to flip the instrument at the midline
● Handle is parallel to long axis of surface scaled
● Insert at midline and scale into the interproximal area
● For use in the posterior region:
o Working end that adapts to the distal = secondary blade
▪ Use from the distal line angle toward the distal surface and interproximal
o Working end that adapts to the mesial = primary blade
▪ Use from the distal line angle towards mesial surface and interproximal
● Type of stroke:
o Oblique strokes on buccal and lingual surfaces
o Vertical strokes on mesial and distal surfaces

Session 3: Probing, Explorer Indices:

● Probe = primary instrument in the periodontal exam
o Used to assess:
▪ Depth of sulcus
▪ Sulcus topography and shape
▪ Gingival bleeding on probing
▪ Gingival recession
▪ Consistency of tissue
▪ Size of lesions
▪ Detection of mucogingival junction to measure amount of attached gingiva
▪ Mobility
o Has 3, 6, 9, 12 mm markings
o Thin working end
● Interpreting the measurements:
o Probing depth 2 mm = healthy (gingival margin to JE)
o Recession = 3 mm (CEJ to gingival margin)
o Attachment loss = 5 mm (CEJ to JE)
● Insert to the junctional epithelium
● Gentle! = Approximately 25 grams of pressure
● Probe is parallel to long axis of tooth
● Interproximal angulation = Probe should be slightly tilted (20 degrees) apical to
the contact
● Working end should be well adapted to the tooth! = Key to painless probing
● Probing technique:
o Walk probe in small steps = 1 mm increments along the junctional epithelium
o Parallel to long axis of the tooth for buccal and lingual surfaces
o For interproximal reading you should slightly angulate the probe = 20
degrees
▪ Want to be under the contact area and into
the col
● Should take 6 total readings per tooth!
o Distal = DB & DL
o Buccal or lingual
o Mesial = MB & ML
● Take the deepest reading within the designated areas
● MBI = Marginal bleeding index
o Do NOT walk the probe
o Sweep the probe around the free gingival margin
o Observe 4 sites per tooth = (distal, facial, mesial,
lingual)
o Count bleeding sites!
𝑇𝑜𝑡𝑎𝑙 𝐵𝑙𝑒𝑒𝑑𝑖𝑛𝑔 𝑆𝑖𝑡𝑒𝑠
o 𝑀𝐵𝐼 = × 𝑇𝑜𝑡𝑎𝑙 𝑇𝑒𝑒𝑡ℎ × 100
4 𝑠𝑢𝑟𝑓𝑎𝑐𝑒𝑠
● PFI = Plaque Free Score
o Done to assess the patient’s oral hygiene status
Apply disclosing solution
o Observe 4 sites per tooth = (distal, facial, mesial, lingual)
o Look at cervical area
𝑆𝑖𝑡𝑒𝑠 𝑤𝑖𝑡ℎ 𝑛𝑜 𝑝𝑙𝑎𝑞𝑢𝑒
o 𝑃𝐹𝐼 = × 𝑇𝑜𝑡𝑎𝑙 𝑇𝑒𝑒𝑡ℎ × 100
4 𝑠𝑢𝑟𝑓𝑎𝑐𝑒𝑠
𝑆𝑖𝑡𝑒𝑠 𝑤𝑖𝑡ℎ 𝑝𝑙𝑎𝑞𝑢𝑒
o 𝑃𝐼 = × 𝑇𝑜𝑡𝑎𝑙 𝑇𝑒𝑒𝑡ℎ × 100
4 𝑠𝑢𝑟𝑓𝑎𝑐𝑒𝑠
● Explorer: used to detect and assess the following:
o Supragingival calculus
o Subgingival calculus
o Cemental irregularities
o Dental caries
o Decalcification
o Irregularities in margins of restorations
o Secondary caries around restorations
o Morphologic crown and root anomalies
o External root resorption
● Narrower shank = increased tactile sensitivity
● Heavier and wider explorers are best suited for caries detection and exploration around
restorations
o Ex.) Shepherd’s hook, pig tail
● Fine diameter explorers are best for subgingival use
● For deep periodontal pockets a longer shank is recommended
o Ex.) 3-A explorer, 11/12 explorer
 ● XAE 11/12 Explorer: this is the instrument we used in clinic!
o Double working ends
o Use the end whose curvature adapts towards the tooth
o Modified gen grasp
▪ Want to use a feather light grasp – you want to detect calculus, NOT remove it!
o Move grasp further away from the working end as you go from anterior to posterior
o Insertion with the lower 1-3 mm of the explorer tip until JE is reached
o Adapt explorer tip to the root surface
o Stroke type:
▪ Vertical strokes at the interproximal surfaces
▪ Oblique/horizontal strokes on buccal and lingual surfaces with push and pull
strokes
o Terminal shank should be PARALLEL to the surface you are exploring!
o Extend strokes under the contact area
o Light pressure!
● Nabors probe
o Used for detection of furcation involvement
o Curved shank with blunted tip (looks like a very thin anterior sickle scaler!)
o Large curved working end
o Calibrated in mm increments
o Determines depth of furcation
▪ Grade 1: indentation fossa up to 1 mm depth
▪ Grade 2: can insert into furcation area, may be radiographically evident
▪ Grade 3: thru and thru radiolucent, not clinically
▪ Grade 4: clinically can see the furcation
● To detect mobility use the end of the probe and the end of the mouth mirror ➔move in the
buccolingual direction
o Gradation of mobility:
▪ Mobility 1 = tooth moves up to 1 mm in horizontal direction
▪ Mobility 2 = tooth moves 1+ mm in horizontal direction
▪ Mobility 3 = tooth is vertically depressible

Session 4: Sharpening
● Why sharpen?
o Easier calculus removal
o Improved stroke control
o Reduced number of strokes
o Increased patient comfort and satisfaction
o Reduced clinician fatigue
● When should you sharpen?
o First sign of dullness
o Sharpen during treatment
o Do NOT sharpen instruments after patient is dismissed
 ● Sharpening technique:
1. Set up stable work surface
2. Good light source
3. Hold an instrument in your non-dominant hand toe
facing towards you
4. Position – face of the blade is parallel to the floor
5. Hold a stone against the cutting edge at 90 degree
angle and then open up to 110 degrees
● Start from the heel 1/3rd, then middle 1/3rd, and finally toe
1/3rd
● Smooth up and down strokes and always end with down stroke!
● Repeat as needed until blade is sharp = 2-3 times is usually sufficient
o Use light reflection to determine sharpness
▪ Reflection of light = dull
▪ No reflection = sharp

Powered Instrumentation
● Ultrasonic and sonic instruments are used for removing hard and soft deposits from the
supragingival and subgingival surfaces of the teeth

Ultrasonic
- Magneto-strictive = electric energy to
metal stack (elliptical to orbital motion)
- Piezoelectric = electric energy to ceramic
discs (linear motion)
- Converts high frequency electric current
into mechanical vibrations
Sonic
- The tip is attached to a high or slow speed
handpiece
- Compressed air energy is the source to
produce vibrations
- Motion = elliptical to orbital

● Power: changes the length of ultrasonic wave

● Frequency: cycles per minute
● Motion: orbit or linear
● Water: light misted spray

Standard Power Scaling Insert Periodontal Power Scaling Insert

- Standard diameter - Slim
- Medium power setting - 40% thinner than standard
- Used for moderate to heavy calculus - Low to medium power setting
- Used for light debris and deplaquing

● NEVER apply the tip directly to the tooth at a 90 degree angle

● Advantages of ultrasonic instrumentation:
o Increases access beyond the tip of instrument
o Patient comfort
o Less tissue distension
o Healing benefits of lavage and irrigation
o Reduced operator fatigue
o Sharpening NOT required
o Delivery of antimicrobial medicaments
● Disadvantages of ultrasonic instrumentation
o Less tactile sensitivity
 o Heat production
o Noise
o Patient discomfort
o Limits visibility
o Water control/evacuation needed
o Production of contaminated aerosol
o Medical contraindications
o Potential occupational hazard
● Advantages of hand instrumentation:
o Greater control
o Increased tactile sensitivity
o Area specific design for greater adaptability and access
o Combination of hand scaling and ultrasonic scaling will achieve maximum results
● Contraindications for power driven scalers:
o Predisposed to infection
o Non-shielded pacemakers
o Existing respiratory disease
o Infectious disease transmitted by aerosol
o Children
o Area of demineralization
o Margins of restorations
o Extreme sensitivity
o Dental implants
● Infection control:
o Wear PPE’s
o Use high volume evacuation
o Pre-procedular antimicrobial rinse for 30 seconds
o Face shield is recommended
o Flush water lines for at least 2 minutes
o Never touch the metal stack with contaminated hand
● Instrumentation criteria for ultrasonic:
o Select appropriate tip
o Use the lowest effective power setting
o Adjust to the adequate water volume
o Use light modified pen graph
o Light but stable fulcrum
o Adapt the insert to the tooth and root
o Use a light, smooth, gentle touch
o Keep the insert tip in motion at all times, use overlapping, horizontal vertical or oblique
strokes
● Care and maintenance:
o Rinse and dry well before sterilization
o Inserts should be replaced yearly
o More than 2 mm loss of tip = 50% loss of efficiency
o More than 1 mm loss of tip = 25% loss of efficiency
o Metal stack should be straight without separation