chp 28

barnhart 5/6 uni curet

short lower shank

rigid or regular flexability of shank

USE- perio debridment of supa and sub biofilm/calc

on all anterior tooth surfaces

posterior area with healthy shallow probing depth

suter barnhart ½ uni curet

long lower shank

ridig or reg flex

USE- perio debridement of supra and sub biofilm/calc

the more bent the shank- easiser to reach interproximally

straigher- buccally / lingually

all posterior teeth with mod-deep pocket

mcCalis 17/18 uni curet

longer lower shank

shank- thick rigid

blade- thick heavy

use= instrumentation of supra and sub biofilm /calc

less bent curved shank- buccal/lingual

bent- interproximmaly

all post teeth mod-deep probing depth , retractable tissue, heavy calc

10/ll loma linda

longer lower shank

regular flex

long blade

use= perio debridemnt of supra/sub biofilm calc

on posterior teeth mod-deep probing

good for line angle

shank strength

standard- healthy or maintence pt light calc

ridgid -moderate to heavy calc

shank length

standard- healthy maintenance pt

extended - deep perio pockets

blade size

standard- healthy to periodontally invovled pt

mini- deep , narrow perio pockets and furcations helps precise debridment

micro- tight narrow pockets , furcation,line angles

modified gracey- easier access into tight, healthy tissues

gracey ½ , 3/4, 5/6 area specific curets

1/2- straight

¾ bent

5/6 straight

uses - perio debridement of supra and sub biofilm and calc ON MAX and MAN ANT ICNSIORS AND CANINES

gracey 11/12 and 15/16

uses - perio debridement of supra and sub biofilm on MAX and MAN molar AND PRE MOLAR MESIAL SURFACES

gracey 13/14 and 17/18

13/14 shank is angulated for adaption to distal

17/18 longer terminal shank with highly accentuated angles for getting distal post surfaces

uses- perio debridemtn of supra and sub biofiilm and calc on MAX AND MAN MOLAR AND PREMOLAR OF DISTAL SURFACES

area specfic curets

shank design with universal blade

standard or minibladed or standard or extend shank

uses- perio debridemnt of supra and sub biofilm and calc ON ANTERIOER AND POSTERIOR TEETH

ANTERIOR SICKLE SCALERS u-15 , sh 6/7, shg 6/7

paried , curved sickle design

blade- long, thin with long rounded back

shank- short lower shank with slight angulation

use- anterior and premolar supra and sub calc removal

not for root planning

anterior sickle scaler sh 5/33

double ended with straight sickle on one end and curved on toher

blade- thin

use- for anteiro and premolar supra and sub calc removal

not for root planning

SCNEVI 1 anterior sickle scaler

elongated disc end with an anterior curved sickle

uses= anterior ingula and supra and sub calc and stain removal and a thin curved balde for interproximal instrumentation (biofilm and calc removal)

not for root planning

posterior sickle scaler s204sd

paired contra angle curved sickle

shank- bent twice

blade- small

shank- lower bent

use for supra gingival and sub gingival calc removal

post sickle scaller SCINEVI 2

paired contral angle curved sickle

shank- small bent

blade- long and thin

use for supra gingival and subginvial calc removal

thin blade removes light calc

post sickle scaler nevi 4

paired curved shank

blade- long and thin

shank- lower shank curved

use for supra nad sub gingival calc removal

curved shank is ideal for interproximal acess in anterior and post

dh providing perio debridement for pt wiht perio pockets and moderate to sever inflammation, what hand instrumetn shank design variation will give most effective and effficent resutls. and what is best for removing heavy calc

dh has gracey curets but is having trouble inserting vertically inot deep narrow pockets. root surfaces have concavites and challenign to access. what gracey blade design variation could they choose to reduce tissue distention, easy insertion and adaption>

Hand activated instruments

used in caring for the FULL spectrum of pt with health AND DISEASED PERIODONTIUM  

Hand instrumentation is

the gold starndard for nonsurgical perio treatment  

why is treating perio inflammation important

Treating perio inflammation is essential for oral and overall systemic health  

Parts of the instrument  

Handle (longest part where we grasp)  

Shank ( functional and terminal (neck that connects to working end))  

Working end ( terminal shank to end of insturement (contacts with tooth)  

handle? why is it important? diff types

•  transmits vibration to our hand  

• Handle type can benefit comfort and ergonomics  

• The design can reduce RSI (repetitive strain injuries

important factors of handle to decrease RSI

• Material- metals ,resisn, silcones  

• Diameter- larger diamertes reduce upper extermity pain than smaller (pinch force)  

• Weight- soild or hollow ( lighter, less strain,greater tactile sensitvity)  

Knurling- patter or relief that assists with grasp and control (common shapes are round/hexagonal)  

shank what are the two types

Functional- starts from bend nearest the handle to the tip of working end  

Terminal – from the last bend or curve closet to working end 

what does the length of shank do

Shorter lower shank is best suited for.... anterior teeth with shallow probing depth, supragingival procedures, fulcrum close  

long lower shank is need for ….. deep periodontal probing depth/recession, need to fulcrum bigger distances  

for perio shank how do they have curves

yes Perio have curved or bent shanks in one or two places  

does the degree of angles and curves in a shank determine anything?

ANGLE OF CURVATURE DETERMINE THE AREAS WHERE INSTRUMENT WORKS BEST  

smaller angles or few bends

anterior teeth

larger angles and lot of shanks bend

posterior teeth

what is strength and flexibility determined by

type of metal and thickness of diameter from handled to working end  

why is flexability important

in transmitting virbation from working end to clinican for increased detection  

shank flexblity is important characteristc to determine the strength of treatment instrument as it transfers clinicans pressure on handel and shank to working end against tooth 

normal flex shank

detect and remove light sub calc

moderate flex shank

light to moderate calc

rigid

Remove tenacious moderate to heavy calc 

 Firm resistance agaisnt hard deposits 

extra rigid

Move tenacious and heavy calc strong and unyielding resistance  

working end

Each designed for specific task and determines general purpose of instrument 

why is balanced instrument important

Allows for msot effective transfer of finger pressure on the handle to working ends  

three types of mouth mirrors

front, concave, flat  

what are explorers

Tactile sensitivity  

Have narrow shank diameters to allow an increased tactile sensitivty to id physical properties of the mouth  

difference in the explorers is the curvature

of shank, length and diameters make them useful for specfic purposes on tissue, calc, probing depth  

Heavier and wider or medium diamerter are study explorers

no bend during mainpulation  

Fine and elongated explorer

increased tactile sensitivyt to help detection 

Bent and long designs of explorer

help accessing the increased depth by apical migration  

Short curved or acutely bent explorers

shallow sulcus areas around CEJ 

Tactile exploration need before

during and after instrumentation

if there is light calc in a shallow probing depth how much pressure is needed

gentle extration of pressure needed  

if there is burnished calc or irregular changes in the root from instrumentation

Increased pressure is needed

function of Probe

Measure and evalute oral health  

Different selection, desgin, color coded marking can be choosen  

what is need for the dh to diagnosis and plan treatment and refferal for periodontal

Need a full mouth of probing for accurate and comprehensive diagnosis

Furcation probe

adapt to architecture of multirooted teeth

types of probes and their designs

Mariquis	Thin round and tapered / thin tip and is color coded at the 3,6,9,12
UNC 12/15	Thin round and tapered/ thin tip maked in increaments of 1mm endings  12 is for maitence and 15 is for attachemnt loss
novatech	Upward and right angled bend -  limited to distal surfaces
Screeing probe	Thin , round, tapered/ thin tip with a ball tip / measuremnt at .5,3.5.5.5,8.5,11.5
nabers	Round ,tapered, curved / blunted tip
implant	Thin round and tapered/ thin tip or ball . Colored coded

treatment insturments

Removal of calculus in debridement  

Use modified pen grasp and proper fulcrum  

curets

is a treatment instrument for nonsurgical perio therapy--> one face, two lateral surface and a rounded back and face = join a toe 

what is a uni curet used for

Supragingival and subgingival Perio debridement in ALL AREAS OF MOUTH  

Characteristics of a curet

face of blade is at a over 90-degree angle to the lower shank, blade is formed with lateral surface converging to a round back to reduce trauma to subgingival sulcular tissues ,

both cutting edges are parallel and curved upward towards toe of blade  

 Universal blade on anterior teeth:  

• Exchanging working ends differ by angulation or the open blade  

• More open angulation increaseds traction and reduces burnishing calc 

• Less open angulation decreases inadvertent soft tissue trauma  

Universal blade on post teeth 

• Critical working ends are not the same for facial and lingual surfaces  

• Best for facial and lingual  is used for mesial and distal interproximal surfaces  

area specfic curets

• Shank with different strengths/lengths and blade sizes  

• Help the subgingival instrumentation need of periodontally involved dentitions  

• Graceys  

Shank- rigidity, less flexibility= heavy perio debridment  

Less bend= less lateral pressure on tooth 

Gracey curet:  

• Widely used area specific curet for designated areas in the mouth  

• Effective for instrumentation of teeth with slight to sever periodontitis  

how is gracey uni curet useful

• Useful due to the face is at 90 degrees it is offset  at an angle of 60-70 degrees to the lower shank  

• Lower shank is parallel to the tooth surface  

• Gracey instruments are efficient in adapting to root morphology 

Extended shank curets:  

Modified set of gracey curets that are exactly like tradaitonal gracey curets BUT the lower shank is 3mm longer  

Useful in areas with probing depth high or a lot of recession

what do you want to avoid with a extended shank curets

Avoid interference of contact with the tooth and allows access to the base of the pocket  

mini bladed curets

• Terminal shank longer than 3mm and a working blade half the length and is thinner than a Gracey  

• Useful in narrow , deep pocketing 

vertical stroke 

Micro mini bladed Gracey curets:  

• Ultra slender blades and shank rigidity  

• 20% thinner  

• Reduce tissue distention and ease subgingival insertion  

• Help precise periodontal debridement in challenging pockets  

larger curets

• Have bends of a Gracey shank with blades of universal curet to scale all tooth surfaces  

• Sets of four for use in anterior and posterior areas  

what does the design of the larger curets do

Design allows the clinician to adapt the scale both mesial and distal surfaces with the same treatment end  

Maintenance Gracey curets

modified area specific curets for routine maintenance appointments  

Useful for pt with tight, healthy tissues, residual pocket depths and or recession.  

Thinner or smaller blade and a closed angel with a longer lower shank

what is a sickle scaler desgin

• Pointed back, two lateral surfaces, two cutting edges, and a face that joins to form a pointed tip  

• Working end= 90 degrees to the shank  

• Shaper point for the sickle tip  

advantages and disadvantages of sickle scaler

• Advantage – ability to reach between very tight contacts  

• Disadvantages- no adapt well to rounded tooth surfaces  

what are the pull stroks action for a sickle scaler

Pull stroke action in a vertical/oblique direction  

v-shaped desgin of sickle scaler

• sturdy in strength  

  • Need for removing heavy calculus less likely tip breaking than curet  

• Fracturing and cleaving deposits  

why are curved bladed sickles popular and are thinner with slight bends

allow anterior and posterior versatility  

curved blade designed are effective for

• moderate ot heavy subgingival calculus removal  

Straight shank of sickle scaler

traditionally anterior instruments (single ended (mesial and distal)) 

• Anterior teeth one is better for mesial and the other distal  

• Postieor teeth is used for both mesial and distal  

hoe and chisel scalers

Purpose to dislodge large ledges of claclulus and remove stains from supragingival surfaces  

hoes use what kind of stroke

used with a vertical pull stroke for facial and lingual surfaces or ant /post of mouth  

chisel use what kind of stroke

push stroke between teeth and facial and lingual surface of ant teeth in mouth 

how does the hoe and chisel make it easier for the curet

This helps it make it easier for the curet to attach onto and break the piece from the tooth  

Pull stroke method 

Furcation instruments:  

To access small, narrow areasm and concave root surfaces  

But light deposits and fine interradicular surfaces  

Effective debridement of furcation areas during maintence help prevent bone loss  

why is tactile sensitivity important

Important in seeing sulcular soft tissue wall, junctional epi and osseous exposures  

when a explorer contacts soft tissue

bounces and snags along the wall untill adapted  

explorer hits a healthy junctional epi it should feel

junctional epi healthy sulci= firm and elastic  

explorer hits inflammed JEpi

soft and easily penetrable with sharp pointed instrument  

three ways to see if instrument is sharpen

• Visual test- need strong light to see the roundd cutting edge that is seen from a blade that is dull  

  • Sharp instrument wont refelct light  

• Tactile test- see on hard platci testing stick at proper angulation. Must test fully across length of balde  

• Auditory test- lack of pinign sound when agulated and adapted  

prevent tip breakage

sharpening narrows working end best to discard worn scalers that are too thin (not safe)  

complications of tip breakage

- pt trauma  and distress and stress to DH. Make sure pt does swallowed or apirated the tip , DH is held iable and must provide medical intervention for the pt 

how to manage tip breakage

must retrieve the tip when breaks, instrumentation must stop as tip is broken and pt must be informed, spit out (tease out tip by other instruments, magentic tip periorievers, open flap perio surgery) radiography is helpful to locate tip  

component of proper instrumentation

Positioning= proper location and alignment of DH to pt is need  

Field of vision= keeping treament area visable and accessible (increase safety, effectiveness, less eye strain and body)  

Grasp= holding instrument  

Body mechanics- pt poisitioning, fulcrum, to decrease DH injury  

Fulcrum-

working hand is supported and pivots for stability and is primary soruce of  strength/leverage on which the finger rest and pushes to hold instrument during stroke 

where is fulcrum placed

Firm on tooth or ossesous structures 

does the fulcrum move when you move

yes

Flexible enough for exploring to allow for the explorer to move along surfaces  

Not all exploring fulcrums can be used as scaling fulcrum because scaling need more stability  

intraoral fulcrum can be placed in the mouth on

Pointed occlusal, incisal, lingual or face surface of a tooth close to the one being worked on  

when is it most powerful when the intraoral fulcrum

Middle finger should make contact with ring finger even if bent or making digital moves  

• Most powerful when do this 

when making a stroke is it only the fingers that move

no

Same time finger and wrist movement to make a stroke

fulcrum on lower left post distolingual ring

finger placed on buccal of post teeth and middle finger palced on occulusal pivoting point = stable powerful stroke  

types of intraoral fulcrums

Finger on finger , tooth surface on opposite arch near area being scaled (opposite arch fulcrum)

surface same arch but across from area being scaled (cross arch)

index finger of nondom hand placed in vestibule to aid assessing diststal and bucals on same arch  

lateral pressure:  

Pressure of the anterior third of the working end of instrumetn against the tooth . Very light to firm pressure (vary based on what is being done) 

Using thumb and middle finger during insturmentation  

Need proper positiong of pt , graps, fulcrum, basic control of instrument  

does the degree of pressure affect tactile sensitivity

yes

Degree of lateral pressure affect tactile senstivity