Dr.

Mosaad

PERIODONTAL INSTRUMENTS
Periodontal instruments are designed for specific purposes, such as removing calculus, root panning, curetting the soft tissue wael of .periodontal pockets for removing the diseased tissues

CLASSIFICATION OF PERIODONTSL INSTRUMENTS .periodontal probes-1 .explorers-2 .(supragingival instruments (scaler -3 .(subgigival of instruments (curettes-4 -: Any instrument is formed of .(Handle(shaft-1 .Shank-2 (.Working end(plade -3

EXPLORERS
USES*

.They designed with different shapes and angles for a variety of uses .I-Before treatment 1-identifying local predisposing factor .locate sub gingival deposit and carious lesion -2 .surface fissuring and irregularities -3

.II-After treatment 1-ensure the removal of the local factor completely check smoothness of the root surface (after root -2 .(planning

TYPES*

.N.B. all have the same tip ,but differ in the shank Explorer no. 17-1 (Explorer no. 23 (used in posterior teeth -2 (Explorer no. 3 (caw horn explorer -3 .Pig-tail explorer-4 .Extended explorer 11-12 has long shank, used for inaccessible areas -5

PERIODONTAL PROBES

The typical probe is tapered, rod like instrument calibrated in millimeters, with a blunt, rounded tip. Ideally the probes are thin, and the shank is angled to allow easy insertion into the pocket. When measuring a pocket , the probe is inserted with a firm , gentle pressure to the bottom of the pocket. The shank should be aligned with the long axis of the tooth .surface to be probed

USES*
.to measure the depth of pockets and to determine their configuration -1 .amount of loss of attachment measurements -2 *.Pocket depth:-distance between the gingival margin & pocket base .loss of attachment:-distance between the CEJ & the pocket base * NAME Marquis periodontal-1 .probe UNC 15-2 LENGTH 12mm 15mm.it is the longest probe so used in deep .and inaccessible area CALIBRATIONS It has 4 divisions each .measure 3 mm It has millimeter markings at each millimeter and color coding at the 5th , . 10th ,and 15th It has marking at each .millimeter

TYPES*

3- Michigan O with Williams graduation.

10mm.it is the standard and the most .commonly used 8mm

4-Michign O

.WHO probe-4

mm.it has a ball 11.5 0.5mm at its end to prevent trauma to the junctional epithelium. it is used to prevent detachment of the bottom of the .periodontal probe

It has millimeter marking at 3.5,8.5 and 11.5 millimeters and color-coding from 3.5 .to 5.5 mm

Nabers probe
They used to identify the furcation involvement and to measure the .depth of destruction .1N identify the furcation area facially and lingually .2N identify the furcation area proximally .3N identify the amount of destruction by grades

SCALERS
THERE ARE FIVE BASIC SCALLING INSTRUMENTS .CURETTES, SICKLE,SCALER FILE,CHISEL,AND HOES Scaling is the mechanical removal of any deterious material above the .tooth surface

(SICKLE SCALER(supra gingival scaler-1

They have flat surface-1 have 2 cutting edges that converge in a sharply pointed tip. so the tip is -2 .strong to avoid its breakage off during use due to its design it is difficult to insert a large sickle blade under the -3 .gingival without damaging the surrounding gingival tissue triangular in cross section-4 .pull technique-5 . USES used for supragingival scaling *-6 no mesial or distal, no right and left, no upper and lower, only anterior -7 .and posterior TYPES* U15 used in anterior teeth (short straight shank) the angle between -1 .shank and blade=90 .(U30 used in posterior teeth (contra angled long shank -2 jaquette scalers used in posterior teeth. they are no.1,no2,no.3 -3 .increasing shank diameter with more contra angles

(HOE SCALER (sub gingival-2

they are .(expansive (more than one according to the tooth contour -1 .have very small blade so by time it is lost by resharpining -2 .pulltechnique-3 .fixed angle 99 between shank and blade -4

the cutting edge is formed by the junction of the flattened terminal -5 .surface with the inner aspect of the blade .the cutting edge is beveled at 45 degree -6 the blade is slightly bowed so that it can maintain contact at two -7 .points on a convex surface for maximum stability the back of the blade is rounded and the blade has been reduced to -8 maintain thickness to permit access to the roots without interference .from the adjacent tissues .types according to anatomy of the tooth ,Hoe scaler is used as following the blade is inserted to the base of the periodontal pocket so that it -1 makes two point contact with the tooth. this stabilizes the instrument .and prevents nicking of the root the instrument is activated with a firm pull stroke(75 degree) toward -2 the crown, with every effort being made to preserve the two point .contact with the tooth

USES used for scaling of ledges or rings of calculus. they have many *-9

STRAIGHT CHISEL-3
they are .USES used in the inter proximal surfaces of teeth * -1 .usually used in the anterior part of the mouth _2 double ended instrument with curved shank at one end and a straight -3 shank at the other, the blades are slightly curved and have a straight .cutting edge beveled 45 degree .push technique-4 .rctangular in cross section-5 .used carefully to avoid lingual artery trauma -6 : It is used as follow It is inserted from the facial surface .the slight curve of the blade makes it possible to stabilize it against the proximal surface, whereas the cutting edge engages the calculus without nicking the tooth. The instrument is activated with a push motion while the side of the blade is .held firmly against the root

4-FILE
they have 1-a series of blades on a base. No. of edges efficiency. 2-can easily gouge and roughen root surfaces when used improperly(so mot suitable for scaling and root planning) 3-rank angle is the angle between 2 edges =55o in files. 4-edge angle is the angle between edge and the blade =90o -150o

*USES - used to fracture or crush tenacious calculus and to produce

roughness on the calculus surface to be easily removed by other instrument. Some times used for removing overhanging margins of dental restoration. Used to broke large solid parts of calculus.

5-SONIC AND ULTRASONIC SCALER

1-used for removing plaque,scaling,curetting, and removing stain. 2-there are two types of ultrasonic sclera magnetostrictive and piezoelectric. They both alternating electrical current cause the scaler tip to vibrate depending on the manufacture. A-SONIC SCALER -consist of handpiece that attaches to a compressed air lines and uses a variety of specially designed tips. -They receive air converted into elliptical and orbital vibrations so the four surfaces of the scaler tip is in contact - but it has low frequency 2000-65000 cycles/seconds. B-MAGNETOSTRICTIVE ULTRASONIC SCALER -Receive electricity converted into magnetic field then into orbital and elliptical vibrations good adaptation (4 surfaces). -high frequency 25000-45000 cycles/seconds (HERTZ)

C-PIEZOELECTRIC ULTRASONIC SCALER -Receive electricity converted into linear or back and forth vibrations so it is less adapted since only 2 surfaces of the tip is in contact -has high frequency 25000-45000 cycles/seconds

Contra indications 1-patient with artificial pace maker 2-patient with pulmonary, infectious disease as TB, hepatitis to prevent spread of infection. 3-Immunosuppressed patients. 4-pateint with porcelain, composite, glass ionomer restoration coz they are brittle. 5-retard the growth of the root cementum and tooth eruption in young children. 6-pateint with gagging reflex

6-CURETTES
They are 1-finer than the sickle scaler and doesnt have any sharp points or corners other than the cutting edges of the blade, so it can be adapted and provide a good access to deep pockets with minimal soft tissue trauma. 2-each working end has a cutting edge on both sides of the blade and a rounded toe. 3-semicircular in cross section with a convex base. 4-there are cutting edges on both sides of the blade. 5- it could be single or double ended.

*USES

it is the instrument of choice in removing deep subgingival calculus , root periodontal pocket.

*TYPES

Area used Cutting edge Blade angle

Universal curette *Used in any area or surface . *Blade is perpendicular on the shank(not offset *curved in one plane: blade curved up not to a side *two cutting side used the outer and the inner) *Two sharp edges(semicircular

Gracy curette *used in mesial,distal,facial,plateal *Offset angle 60 70, Offset angle: between blade and shank. *curved in two planes: blade curved up and into a side. *One cutting side used the outer edge. *One sharp edge and other one is dull

Curvature

uses

NOTE: as the length of the shank increases => angles in the shank increases => so used in poster

Gracy curette 1-2 3-4 5-6 7-8 Facial, mesial, distal surfaces of the anterior. Palatal, lingual surfaces of anterior. Premolars + anterior. Promolar+molar.

9-10 11-12 13-14

Facial surface of molars. Mesial surface of molars. Distal surface of molars.

Modification
*15-16

- It is modification of the standard 11-12 - Have blade of 11-12 - have the more acutely angled 13-14 shank, so allow better adaptation to posterior mesial surfaces from a front position with intra oral rests. -Used by intra-oral rest for mesial surface of most posterior teeth. *17-18 -It is modification of the # 13-14. -plade of 13-14 -Increase length of shank by 3mm. -more accentuated angulations of the shank to provide complete occlusal clearance and better access. -Used in distal surface of posterior teeth. -the horizontal handle position minimizes interference from opposing arches and allows a more relaxed hand position when scaling distal surfaces. In addition, the blade is 1 mm shorter to allow better adaptation of the blade to distal tooth surface. *EXTNDED SHANK CURETTES -Extended shank curettes such as Hu-Friday AFTER FIVE CURETTES -They (after five curettes) are modification of standard gracy curette design. -The terminal shank is 3mm longer, allowing extension into deeper periodontal pocket of 5mm or more. -Thinned blade for smoother sub gingival insertion and reduced tissue distention. -Larger diameter, tapered shank. -All standard gracy numbers except for the #9-10 are available in the after 5 series. -They are available in two forms 1-RIGID DESIGN: used for heavy or tenacious calculus removal. 2-FINISHING DESIGN: used for light scaling or deplaquing.

*MINI-BLADED CURETTES. -Mini-bladed curettes such as the Hu-Friday MINI FIVE CURETTES. -They (mini five curette) are modifications of the after 5 curettes. -The blades are half the length of the after 5 or standard gracy curette, so allow easier insertion and adaptation in deep; narrow

pockets; furcations; developmental grooves; line angles; and deep, tight, facial, lingual or palatal pockets. -Used with vertical strokes without tissue distention or trauma.. -Used in area where root morphology or tight tissue prevent full insertion of standard gracy or extended 5 curette. -All standard gracy numbers except for the #9-10 are available in the mini bladed after 5 series. -They are available in two forms 1-RIGID DESIGN: used for calculus removal. 2-FINISHING DESIGN: used for light scaling or deplaquing.

THE GRACY CURVETTES -They are another set of mini-bladed curettes. -The Sub-O and the #1-2 are used for anterior and premolars. -The #11-12 is used for posterior mesial surfaces. -The #13-14 is used for posterior distal surfaces. -The blade length of theses instruments is 50% shorter than that of the conventional gracy curette. -They have precision-balanced blade tip perpendicular to the handle, and a shank closer to parallel with the handle. -And the blade has curved slightly upward, this curvature allows the gracy curvette to adapt more closely to the tooth surface than any other curettes, especially on the anterior teeth and online angles. -This curvature also carries the potential for gougig or grooving into the root surfaces on the proximal surfaces of the posterior teeth when the gracy curvette #11-12 or 13-14 are used.

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