Instrumentation

All types of instruments have the same design as they are divided into the same "3" parts
which are:
 Handle.
 Shank.
 Working end which is divided into tip (toe) & blade (cutting edge)

Classification of PDL instrumentation:

 Diagnostic instruments.
 PDL probe.
 Scaler & curette.
 Surgical instruments.
 Cleansing & polishing.

(1) Diagnostic instruments:

Mirror Tweezer Explorer
 Used for retraction of lips & cheeks  Used for holding gauze &  Uses:
 Used for indirect technique like cotton rolls. o Locate subgingival calculus.
that used with upper teeth. o Locate carious areas (like class V).
o Check smoothness of the root
surfaces after root planning.
 Types:
o Shepherd hook (m.c)
o Cow – horn & pig tail.
o Orban type (its tip is bent)

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(2) PERIODONTAL PROBE:

 FUNCTION:
 Locate PDL pocket.
 Measure recession.
 Measure AG.
 Locate MGJ.
 DESIGN:
o Calibrated in mms with blunt rounded tip (to avoid injuring the JE).
 TYPES:
1
 o Michigan (O) …>> William calibration.
- Calibrated at 1mm, 2mm, 3mm then 5mm, 7mm then 8mm, 9mm, 10mm.
o Naber's probe …>> detection of furcation.
- Has color – coded calibration ( 1st 2mm has silver color → next 2mm is black →
next 2mm is silver again & go in).
o WHO probe …>> with small end ball with diameter of 0.5mm.
- Its calibration isn't uniform (don't have the same length).
- Used for CBITN index (community PDL index for treatment needs) → used to
assess the PDL health & RX.
o UNC – 15 probe
- It's longer than Michigan probe as it has 15mm of calibration, with black mark
for each 5mm.
o Plastic probe …>> used with metal implant …>> WHY??
A. Cause pitting (scratches) in metal implant (prevent metal to metal contact)
B. Cause galvanic current in presence of saliva.
 TECHNIQUE:
o Parallel to long axis of tooth.
o Passive pressure to avoid perforation.
o Slight angulation in interproximal area.

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(3) Scaling and Root planning

[A] Sickle SCALER:

 FUNCTION:-
 Supragingival scaling (if used subgingivally → gingival injury).
 DESIGN:-
o Triangular cross section.
o Flat surface.
o 2 cutting edge & pointed tip.
 TYPES:-
 Jacquette (has 2 similar working ends) & ( has different types according to angulations of the
shank).
 Mitchel .. have double ended:
 Sickle end ..> interproximal.
 Spoon end ..> buccal & lingual at molars.
 U15 /30 .. have double ended (Jackette & Sickle).
 CK6 .. surgical scaler (remove granulation tissue after flap opening) & similar to Jacquette
except its blade is very large.
 TECHNIQUE:-
2
  Adaptation →Work with inner last third of blade not middle nor tip (provide control)
to prevent tissue injury.
 Work with pulling stroke (press it against the tooth then pull it out).

[B] HOE SCALER: ‫شبه الجاروف‬

 Terminal end of blade is bent → this part adapted on tooth surface & used in pulling mvt (not
pushing)
 Used subgingival.
 Achieve 2 points contact (one at the crest of curvature of tooth & other end at the tip of blade which
is pulled to remove calculus)

[C] CHISEL SCALER:

 Curved working end
 Used with push MVt.
 May push the calculus in gingiva ..>> gingival abscess (risky) so not used anymore.

[D] FILE SCALER

 Cause roughening of root surface, not used anymore.
 Used to smooth overhanging amalgam restoration or sharp bony area during surgery.

[E] CURETTE:
 FUNCTION:
o Remove subgingival calculus.
o Root planning.
o Gingival curettage.
 DESIGN:
 Semicircular cross section.
 Rounded tip.
 1 or 2 cutting edges.
 TYPES OF CURETTE:
Area Specific (Gracey) Universal
Area of use  Set of many curettes for Specific areas &  One curette for all areas & surfaces.
surfaces.
Cutting edge  One cutting edge used.  Both cutting edges used (outer or
 Work with outer edge only. inner)
Curvature  Curved in 2 planes →blade curves up & to  Blade curved in one plane → blade
the side (Offset angle). curved up & not to side (Not offset).
 Offset blade → face of blade beveled at  Face of blade beveled at 90° to
60 degree to shank shank.
Blade angle
Types  Have the same shank but differ in shank Has 2 types
3
 angulation to access different areas. 1. 4L4R (4 quad R & 4 quad L) →
 Designed in the form of double – ended anteriors & posteriors.
instruments → ↓ no. instruments 2. 2R2L ….>> anteriors only.
 Easier to use (come in set of 14 – 18 Difference between 2 types in angulation
instruments) (7 – 9 double ended of shank.
instruments)
 Difference in size & curvature.
 What is the difference between universal & area specific curette:
o 1st hold instrument so that the terminal part of the shank is _I_ on the floor.
o Observe the face of the blade:
 If II to floor (no offset angle) → universal → both edges are cutting edge.
 If it form an angle (offset angle) → area specific curette.

GENERAL PRINCIPLES OF INSTRUMENTS:

1. Accessibility.
2. Visibility, illumination & retraction.
3. Maintaining clean field.
4. Instrument stabilization.
 Instrument grasping.
- Pen grasp.
- Modified pen grasp (stable & more control).
 Finger rest (we rest by ring finger)
- Conventional rest → on adjacent tooth on same side
- Opposite arch rest → on the other side on the same arch
- Cross arch → on the other arch.
- Finger on finger → upper post. Teeth.
- Palm up → is a stabilizing on patient's chin or cheek (upper posterior teeth).
- Palm down → is a stabilizing on patient's chin or cheek (upper post. Teeth)
5. Instruments activation.
(1) Adaptation .
- Face of blade made zero angle with surface of root.
- Face of blade adapted well with surface of root.
(2) Angulation (the angle between the face of blade & tooth surface )
- During scaling → it's between 60 & 80 (70 degree is ideal).
- During root planning → it's between 45 – 60 degree.
- During curettage →it's >90 (obtuse angle).
- The angle is against the root not soft tissue.
- No need for angulation & adaptation with Gracey curette)
(3) Lateral pressure (pressure created when force applied against the surface of tooth with
cutting edge) & usually it's moderate force.
4
 (4) Stroke.
- Vertical stroke → interproximal areas of anterior & posterior.
- Oblique stroke → facial & lingual of

posteriors
- Horizontal
stroke → facial & lingual of
anteriors.

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SURGICAL INSTRUMENTS:
1) Angled Scalpel Handle.
2) Micro – tissue Forceps.
3) Scalpels.
4) Kirkland & Orban Knives.
5) Pocket marker.
5
 6) Periosteal elevator.
7) Micro needle holder.
8) Micro scissors.

Cleaning & polishing instruments:

1. Polishing brush.
2. Polishing cups.
3. Polishing paste.