BY Dr Mohamed H.

Ghazy
Professor of Fixed Prosthodontics
November 3, 2014

Classification
According

to their uses

Diagnostic

Cutting

Diagnostic instrument
A. Traditional diagnostic instruments:

Mirror
Indirect vision
Light reflection
Retraction
Tissue protection

Explorer (Probe)

Distinguish areas of calculus.

Distinguish decay.
Distinguish areas of discrepancies on teeth.

Restoring

Cotton Pliers (Tweezers)

Carry, retrieve and place small objects.
Locking
Non-locking

4. Periodontal probe
Measure the depth of salcus
Accessory

5. Articulating paper and holder

Adjustment of occlusion

 B. New diagnostic instruments:

4. Intra-oral camera.
1. Digital radiograph.
2. Diagnodent Laser
3. Operating Microscope

5. Loupes.
6. DIFOTI (Digital Imaging Fiberoptic

Trans-Illumination

Cutting instruments

Depending on whether mere hand or mechanical

force, are utilized to work out these instruments:

Hand cutting
Powered rotary cutting

Laser equipments

Other equipments

Hand cutting instruments

Manufactured from
Carbon steel
Stainless steel
Carbide steel
Other alloys of nickel, cobalt, chromium

Instrument design
Blade(Working End)

Examples of Hand cutting instruments:

Chisels

Portion of the instrument designed

for a specific function

Hoes

Hatchets

Shank

Part of the instrument that attaches

the working end to the handle

Marginal Trimmers

Angle Formers

Handle

Portion of the instrument where the

operator grasps

G.V. Black describe a way to name dental

instruments:
excavator

condenser

G.V. Black describe a way to name dental

instruments:.

chisel

scaler.
hatchet

hoe

3-The form of its working part, hoe, hatchet, chisel etc.

2. The position or manner of their use e.g. push, pull.

straight

mon-angle

1. The purpose of its use e.g. excavator, condenser,

scaler.

bin-angle

4-The number of angles in the shank, straight- no angle

mon-angle (one angle), bin-angle (two angles), tripleangle (three angles), quarternary-angle (four angles).

Powered (rotary) cutting Instrument

What does the term rotary mean?
(Rotary is a part or device that rotates around an axis.)
In dentistry, rotary instruments are attached to a handpiece.

Power sources for dental units

Electric motor
driven

Handpiece

is a device for holding rotary instruments, transmitting power to them

and for positioning them intra orally

According to shape

Straight handpiece

Compressed air

Contra angle handpiece

Rotary speed ranges

Low speed
(below 12000 rpm)
Medium speed (12000-200 000 rpm)
High speed
(above 200 000 rpm)

Disadvantages of low speed

1- Ineffective
2- Time consuming
3- Require a relatively heavy force
application

Uses of low speed

Initial preparation of grooves and pinholes

Cleaning of teeth
Caries excavation
Finishing and polishing procedures

Advantages of high speed

Faster removal of tooth

structure with less

vibration and heat
production
Better control and
greater ease of
operation
Patient is less
apprehensive because
annoying vibration and
operating time
decreased
Instruments last longer

The rotary tools used in removing tooth structures may be

classified into burs and abrasives depending on whether
they work by an actual cutting or an abrading process.

Cutting tools

Design features

Head

Dental rotary burs

Dental rotary abrasives

Neck

Shank

Shank design
Definition It is the part that fit into the

Neck design

handpiece, and accepts the rotary

motion from it

It is the intermediate portion of an instrument

that connects the head to the shank

Long shank

Function: transmit rotational force to the head

Used with straight handpiece

Short latch shanks

Used with latch type contra angle

handpiece

Friction grip shanks

Used with ultra high speed handpiece

Head design

Is the working part of the instrument, the

cutting edge or portion of which
perform the desired shaping of tooth
structure

Characteristics of the head

1. Type of cutting: Bladed (bur).
Diamond abrasive.

2. Material of Construction:
Carbon steel.
Tungsten carbide.
Diamond ships.
Sand.

3. Head size
4. Head shape

Round
Finishing

End cutting

Inverted cone

Dental bur
(shape)

End and
side cutting

Fissure

Pear
Wheal

Diamond abrasive instruments

Burs flute design

Advantages
Long life
More effective in cutting enamel and

dentin
Plain

Cross cut

Diamond abrasive instruments

Diamond abrasive instruments

shaped stone

Very fine
38-44m

Fine
60-74m

Particle
size

Coarse
125-150
m

Medium
88-125m

Wheel

Round

Spezial shapes

Pointed

Torpedo

Torpedo tapered

Cylinder

Cylinder round

The wheel stone

Round and oval

Cylinder pointed

Cylindrical stone
Tapered stone
Inverted cone stone
Cup shaped stone
Barrel shaped stone
Pear shaped
Bud shaped
Root facer stone

Pear

Cone

Trapered

Tapered round

Wheel

Round

Cylinder

Cylinder round

Pear

Cerafil

Egg

Oval or flame Shaped: used to reduce

palatal and lingual surfaces of anterior teeth.

Wheel Stone: used to reduce incisal edges

Flame

Grenade

in anterior teeth and occlusal planes of cusps of

posterior teeth.
Wheel Stone may be with flat end, round end or
tapered ended stone.

Cone

Barrel and Pear shaped stone:

used to reduce occlusal surfaces of

Bud

Tapered

Tapered round

premolars and molars.

According to function
Tinker Stone: used to perform
shoulder with bevel finishing line

1. Reducer

for PFM restorations.

Fisssure Stone as:

a.

Tapered with round end used to perform

chamfer finishing line for full metal
restoration.

b.

Tapered with flat end used to perform

shoulder finishing line for all ceramic full
coverage restoration.

c.

Cylindrical stone. (long/short) used to

do grooves for partial coverage
restorations.

2. Cutter

3. Finishing

5. Root Facer

4. Guidance Stone
6. Tissue Trimmer

Discs
Abrasive rotary instruments used for
proximal slicing or reduction.
Supplied either mounted or demounted
Used with conventional or slow speed

Discs classification
According to the
abrasive material
Carborandum
Diamond

Metal
Sand paper

10

According to size
Small

3/8 inch

Medium 5/8 inch

Large

7/8 inch

Discs classification
According to shape
Flat shaped
Cup shaped

According to the side

of abrasive material
Safe sided
Double sided

Accessory instruments and items.

Ultrasonic Hand piece

Design
Attached to the dental unit.
Powered by electricity.
Primarily used for prophylaxis

appointments.
Attachments are similar in

appearance to scaling instruments.

Delivers a pulsating spray of water

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Uses of the Ultrasonic Handpiece

Remove calculus
Remove stain
Remove bonding materials from tooth
surface after orthodontic appliances are
removed
Remove cement after orthodontic bands
are removed

Laser Handpiece
Design
Uses a laser light beam

instead of rotary instruments.

Laser is conducted through a

fiber-optic cable.

Resembles a standard

handpiece.

Maintains a water-coolant

system.

Maintains an air-coolant

system.

Uses
Cauterizes soft tissue.
Vaporizes decayed tooth structure.

Advantages
Usually painless.
Patient usually does not require

anesthesia.
Proceed with procedure faster.

Disadvantage
Cannot be used on teeth with existing

restorations.

12

Air-Abrasion Handpiece
Design

Small version of a sandblaster.

Produces a high-pressure delivery of aluminum oxide
particles through a small probe.

Any Questions.
Uses
Prepares teeth for sealants.
Removes external stains.
Class I through class VI preparations.
Endodontic access.
Prepares a tooth surface for the

cementation of a cast restoration, such as

a crown or veneer.

Student question
What is the finish line?
a line indicating the location of the finish of a race

BY Dr
Mohamed H. Ghazy
Professor of Fixed Prosthodontics
November 3, 2014

13

Rotary cutting equipments.

Low-Speed Handpiece.
High-Speed Handpiece.
Ultrasonic Handpiece.
Laser Handpiece.
Air-Abrasion Handpiece.

Ultrasonic Hand piece

Laboratory Handpiece.

Uses of the Ultrasonic

Handpiece
Remove calculus
Remove stain
Remove bonding materials from tooth
surface after orthodontic appliances are
removed
Remove cement after orthodontic bands
are removed

Design

Attached to the dental unit.

Powered by electricity.
Primarily used for prophylaxis
appointments.
Attachments are similar in appearance to
scaling instruments.
Delivers a pulsating spray of water

Laser Handpiece
Devices which produce beams of very high
intensity light

Design
Uses a laser light beam
instead of rotary instruments.
Laser is conducted through a
fiber-optic cable.
Resembles a standard
handpiece.
Maintains a water-coolant
system.

14

LASER WELDING

The effect of laser depends on the power of

the beam and the extent to which the beam
is absorbed e.g. CO2 and ND:YAG Laser
Uses
Cauterizes soft tissue.
Vaporizes decayed tooth structure.

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
Small version of a sandblaster.
Produces a high-pressure
delivery of aluminum oxide
particles through a small probe.

15

Uses
Prepares teeth for sealants.
Removes external stains.
Class I through class VI preparations.
Endodontic access.
Prepares a tooth surface for the cementation of
a cast restoration, such as a crown or veneer.

Impression Trays
Quadrant tray
Covers one half
of the arch.

Section tray
Covers the anterior portion of the arch.

Full arch tray

Types of Stock Trays

Metal perforated tray
Mostly used for preliminary impression

Metal water coolant tray

Mostly used with reversible hydrocolloid
impression

Covers the entire arch.

Perforated tray
Holes in the tray create a mechanical lock to hold the
material in place.

Smooth tray
Interior of the tray is painted or sprayed with an
adhesive to hold the impression material.

Crown remover
Hand instrument.
Crown remover.
Manual crown remover.
Pneumatic crown remover.
Brass ligature wire.
Chisel and hummer.
Sectioning.
Crown slitter.

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Plastic perforated tray

Mostly used for preliminary and final
impression

Manual crown remover

The manual back action hammer is the

classic method for removing prostheses.
It produces the desired force by means
of a weight that slides along a shaft

Spring-loaded back action hammer

allows forces to be directed in a more
controlled manner.

Automatic Crown & Bridge Remover

Non-traumatic way to remove crowns,

bridges and inlays
This water soluble, pliable resin adheres to porcelain, enamel,
gold, acrylic and will not damage restorations. Works quickly
and safely. Ideal for the removal of temporary or permanently
cemented crowns.

Cord Placement Instruments

Crown Collars and Scissors

Used to trim temporary crowns,
gingival cord and matrix bands.

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Instrument Sequence on a Tray

Instruments set-up from left to
right

Preset restorative tray

Basic set-up
Additional examination
instruments
Hand cutting instruments
Restorative instruments
Accessory items

Cleaning and Sterilization of dental instruments

All instruments need to be cleaned and thoroughly

dried before they are sterilized.

Cleaning
Hand Scrubbing

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Ultrasonic
Cleaning

Automated
Washer

Classification of Patient-Care Items

In order to determine the

appropriate treatment for any item
that has been used in patient care,
you will need to classify them into
one of the following three categories
based on the risk of infection
associated with their intended use.
Critical
Semicritical
Noncritical

Clinical Application
What do you use clinically
everyday that is considered a
critical item?
How do you treat these items
before they are used again?

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Critical
Items

Are defined as those

used to penetrate soft
tissue or bone
Since the risk of
transmission would be
Examples:
high, they must be heat Surgical instruments
sterilized
Scalers
Forceps
Scalpels
Bone chisels
burs

Semicritical Items
Touch mucous
membranes or non
intact skin
Have a lower risk of
transmission. However,
if an item can be heat
sterilized, it should be
heat sterilized.

Examples:
Mouth mirrors
Amalgam
condensers
Impression trays
X-ray film holders

Semicritical instruments which

cannot tolerate the high
temperatures of sterilization must
be processed by using a sterilant or
high level disinfectant.
These products achieve sterilization
(kills all forms of life including
spores) after immersion in the
solution for 3 to 10 hours. Follow
manufacturers instructions for the
product in your office.

Immersion Disinfectants FDAApproved for use in dentistry

Sterilants:
Gluteraldehyde -6 to 10 hour contact time
Hydrogen peroxide (7.3%) 6 hour contact
time.
Gluteraldehyde and phen0ol/phenate-12
hour contact time
Hydrogen peroxide and peracetic acid-3
hour contact time.

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Clinical Application
Which items do you use daily
which are considered semicritical?
Do you routinely sterilize these
items?
If not, what is your method for
assuring that they have remained
in the disinfectant or sterilant for
the necessary length of time?

High level Disinfectants

Ortho-phthalaldehyde (12 minute contact time)
Gluteraldehyde- 20 to 90 minute contact time
Hydrogen peroxide- 30 minutes contact time
Gluteraldehyde and phenol/phenate- 20 minute contact
time
Hydrogen peroxide and peracetic acid-15 minute contact
time.

(You must always use personal protective equipment

(PPE), including utility gloves, mask, eyewear, and
protective clothing, when processing instruments)

Definitions to remember.
Sterilization is the process that kills all
microorganisms and is considered the
highest level that can be achieved. It is
accomplished by the proper use of
immersion chemical sterilants or by heat.
High level disinfection is used when a
semicritical item cannot withstand heat
sterilization. Used correctly, it is intended
to kill disease producing microorganisms
but not spores. These products are not
used for surface disinfection, but for
immersion.

Universal Sterilization
means that all reusable instruments
and handpieces are sterilized (rather
than disinfected) between use on
patients.
This provides the highest level of
patient protection.
Miller & Palenik, p. 196

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Noncritical Items
Contact intact skin only.
Have a low risk of disease transmission.
Some of these(*) should be pre-cleaned
and disinfected or barrier protected.
Examples:
Blood pressure cuff
*X-ray cone
Stethoscope
*Lead apron

Sterilization
1. Steam autoclave:
Most effective.
Steam, heat (270 F), pressure (27 PSI).
for at least 6 minutes.

2. Unsaturated chemical vapor:

Best for carbon steel instruments.
Heat (270 F), pressure (20-40 PSI).
for at least 20 minutes.

3. Dry heat oven:

Heat (230 F) for 2 hours.
Temperature above 350 F may cause
premature instrument failure.

Instrument processing
flowchart
Remove
Items from
operatory

Use holding
Solutions if
necessary

Clean by
Automated
Or manual
method

4. Chemical solution:
Package

Used for materials that can not withstand

heat sterilization process.
Not recommended for metal dental
instruments.

Sterilize
Store

Ultrasonic cleaner

Remember to carefully transport

instruments to the sterilization area.

This solution is considered

highly contaminated. Retrieve
instrument cassettes while wearing
utility gloves

Ideally, they should be in closed

cassettes and handled with utility
gloves.
Dont forget to close
the lid during
operation to reduce
aerosols!

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A commercial all-purpose
ultrasonic cleaner.

An enzyme ultrasonic
cleaner in tablet form.

Take care not to overload steam

heat sterilization equipment.
If steam cannot circulate and
penetrate, instruments may not
be sterile.

Packed handpiece

Process Indicators
Do not indicate sterility.
Simply indicate that the
autoclave reached a
certain temperature.
Show at a glance if a load
has been run.

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Instrument Processing
Sterilization Monitoring
Do not use instrument packs if chemical or
mechanical monitoring indicate inadequate
processing.

Personal Protective Equipment

(PPE)
Protects the skin &
mucous membranes
of the eyes, nose,
and mouth from
exposure to blood or
OPIM
Use of PPE is
dictated by the
exposure risk, not
the patient.

Masks and Protective Eyewear

Wear a surgical mask and
protective eyewear with
solid side shields to
protect mucous
membranes of the eyes,
nose, & mouth
Change masks between
patients, or during
treatment if it becomes wet

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Protective Clothing
Wear long-sleeved reusable or
disposable gowns, clinic jackets, or
lab coats to protect skin of the
forearms and clothing likely to be
soiled with blood, saliva.
Change immediately if visibly soiled

Protective coverage

Clinical Contact Surfaces

Housekeeping Surfaces

Environmental
Use surface barriers to protect clinical
contact surfaces, especially which are
difficult to clean.
Change barriers between patients

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