04 - Calculus Removal Instruments

calculus removal terminology

• scaling → supragingival and subgingival removal of plaque, calculus, and stain

• root planing → definitive treatment designed to remove cementum and/or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms

• debridement → gross removal of plaque biofilm and calculus that interfere with the ability to perform a comprehensive oral evaluation

• prophylaxis → removal of plaque biofilm, calculus, and stain

scaling and root planing (SRP)

done to resolve inflammation in periodontal soft tissues by removing irritants, removing supragingival and subgingival plaque and calculus

• delays repopulation of subgingival pathogenic microflora and shift pocket environment from gram-negative to gram-positive

• done during periodontal treatment every 3 months

sickle scalers

2 cutting edges, formed by face and two lateral surfaces, that converge to form the tip of te scaler

• internal angles of approximately 70º, formed where lateral surfaces meet face at the cutting edge

• for supragingival calculus removal

• removal of gross depositis located just beneath gingival margin

  • small curved sickle scalers can go subgingivally (up to several mm)

anterior sickle scaler (SH5/339E2)

straight shank with two cutting edges and pointed tip

• Jacquette 33 → straight blade for broad F/L surfaces; can be used interproximally

• H5 → curved blade for interproximal deposits

• terminal shank is parallel to long axis of tooth

• placement at midline and scaling into interproximal area

  • roll instrument and scale to half the interpximal surfaces; the other half is done on the other B/L side

posterior sickle scaler (S204S9E2 and SN1359E2)

contra-angle shank with 2 cutting edges and pointed tip

• terminal shank is parallel to long axis of tooth

• distal → placement at distal line angle (tip pointing distally); scale into distal interproximal areas

• mesial → placement at distal line angle (tip pointing mesially); scale into mesial interproximal areas

• check the correct working end by placing instrument interproximally; the handle should be going out of the mouth

curettes

two cutting edges that converge into a round toe

• no sharp points or corners othe rthan the cutting edges of the blade

• can be adapted and provide good access to deep pockets with minimal soft tissue trauma

• two types → universal and area-specific

universal curette (Columbia 13/14)

universal instrument to be used on anterior and posterior teeth for supragingival and subgingival calculus removal

• face of the instrument is at 90º angle to terminal shank with rounded toe and rounded back

• two parallel cutting edges:

  • primary cutting edge → farthest from handle

  • secondary cutting edge → closest to handle

• anterior teeth → only primary cutting edge used

  • one end for surfaces away; the other end for surfaces towards

  • handle of instrument is parallel to long axis of the tooth

• posterior teeth → primary and secondary cutting edges used

  • primary CE from D line angle to M (B, L, M surfaces)

    • combinaton of vertical, oblique, horizontal strokes

  • secondary CE rom D line angle to D (D surfaces only)

    • vertical strokes to go into distal interproximal surface

  • terminal shank is parallel to long axis of the tooth

area-specific curettes (Gracey curettes)

face of the blade is at a 60-70º angulation with the shank (offset) so cutting edge is curved to allow curette insertion into deep periodontal pockets without traumatizing soft tissue

• only one cutting edge is used (lower cutting edge)

• to find correct cutting edge, hold the terminal shank perpendicular to the floor

• adapt the terminal shank so that it is parallel to the long axis of the tooth

Gracey 1/2

straight shank used on anterior teeth

• insert the blade at midfacial surface, with strokes directed around the facial surface onto the mesial proximal surface of all anteriors in the quadrant

• flip curette over and do the midfacial and distal proximal surfaces

Gracey 11/12

contra-angle long shank used on mesial of posterior teeth

• insert curette subgingivally at DB line angle on the buccal shank, with terminal shank parallel to long axis of the tooth, and use vertical strokes to scale half-way onto mesial interproximal surface

  • toe faces towards mesial and interproximal

Gracey 13/14

contra-angle shank used on distal surfaces of posterior teeth

• insert curette subgingivally at DB line angle on buccal surface, with terminal shank parallel to long axis of tooth, and use vertical strokes to scale half-way onto distal interproximal surface

  • toe faces towards distal and interproximal

other Gracey curettes

• Gracey 15/16 → modification of 11/12 that consists of 11/12 blade combined with more acutely angled 13/14 shank

  • allows better adaptation to posterior mesial surfaces from a fron position with intraoral rests

• Gracey 17/18 → modification of 13/14 that consists of elongated terminal shank by 3mm and a more accentuated angulation of shank

  • provides better access to all posterior distal surfaces

  • blade is 1mm shorter to allow better adaptation of blade to distal surfaces

types of Gracey shanks

• finsihing → standard

• rigid → larger, stronger, and less flexible shank to allow removal of moderate to heavy calculus without using seaparate set of heavy scalers

  • reduced tactile sensitivity

extended-shank curettes

after five curettes

• modification of standard Gracey curette design

• terminal shank is 3mm longer to allow extension into deeper periodontal pockets of 5mm or more

• thinned blade for smoother subgingival insertion and reduced tissue distension

mini-bladed curettes

mini five curettes

• modifications of after five curettes

• blades are half the length of the after five or standard Gracey curettes

• allows easier insertion and adaption in deep narrow pockets, furcations, developmental grooves, line angles, and deep tight F/L pockets

  • scale pocket as much with regular scaler because it has a much larger surface area and can take away more debris

file, chisel, and hoe scalers

used to remove tenacious subgingival calculus and altered cementum

• use is limited, compared with that of curettes