Intruments

Health and Safety

  • PPE

  • MH

  • Appropriate hand instruments for task

  • Maintain sharp instruments

  • Correct grasp

  • Maintain appropriate finger rest

  • Correct adaptation, angulation and activation

  • Safe wiping of deposits from hand instruments

Equipment and Instrument Kits

  • Rest Exam Kit

    • PCP15/BPE probe

    • Straight probe

    • Tweezers

    • Mirror

  • Combi Perio Kit

    • 2L/2R curette

    • 4L/4R curette

    • Mini sickle scaler

    • Ultrasonic insert

    • Ultrasonic sleeve

  • Student Gracey Kit

  • Cavity Prep Kit

Instruments for sub PMPR:

  • Gracey curette

  • Slimline ultrasonic inserts

Mouth Mirror

  • Indirect vision

  • Retraction

  • Illumination

Retraction of the lip

  • Using a finger can often be more comfortable for the patient

Avoid

  • Hitting the mirror against teeth

  • Pulling the corner fo the mouth with the mirror

  • Resting the mirror against patient soft tissues

Shank

  • Connects the working end of the handle

  • May be angled, curved or straight

  • The more restricted the access, the greater the shank angle needed

  • For anteriors = shank staright

  • For posteriros = shank angled

  • Thickness of shank:

    • Rigid (thicker, stronger)

    • Flexible (thinner, more stactile, sensitivity)

Working End

  • Carries out the function

  • May be single or double ended having paired working ends for access to different surfaces

  • Cutting edge between the face and lateral surface

  • Cutting edges: stainless steel, carbon steel, tungsten carbide, plastic or titanium

Common scalers: curette and mini sickle

Principles of PMPR:

  1. Locate and access deposits:

    Depositis can be located by:

    • Drying the tooth

    • Looking

    • Feeling

    • Listening

    • Using the overhead light

    Subgingival deposits are sometimes visible on radiographis (only interproximally)

  2. Selection of appropriate instrument

    The correct instrument should be used.

    An intrument with a larger working end may be appropriate for removal of supragingival calculus on a molar tooth.

    A smaller working end is necessary for the removal of subgingival calculus

  3. Correct isnturment grasp

    The modified pen grasp is the recommended method for holding a periodotnal instrument. It facilitates precise control of instrument, allows detection of rough areas on tooth surface, and lessens musculoskeletal stress. Gripping toot tight = fatigue and strain.

  4. Finger rest

    Stability is essential for effective and safe control and action of an intrument

    • A finger rest is used as a fulcrum on which the hand turns when moving an instrument

    • It should be maintained throughout the procedure

  5. Adaptation

    • Toe/tip third is kept in contact with the tooth surface

    • First 1-2mm of the working end’s lateral surface is in contact with the tooth

    • Position below the deposit

    • This should be maintained throughout the instruments stroke

  6. Angulaion

    Is the relation between the face of the instrument and the tooth surface to which it is applied

    For successful isntrumentation, correct adaptation and angulation of the working-end must be maintained throguhout the instruments stroke

    • For calculus removal, the ideal angle shoud be between 60-90

    • When scaling below the gingival margin, the angulation during insertion should be between 0-40 to prevent injury to the soft tissue

  7. Activation (lateral pressure, stroke)

    The act of applying equal pressure with th eindex finger and thumb inwards to press the working end against the deposit throughout the stroke. The level of pressure depends on the task. Pressure will range form light to firm, however heavy pressure is not recommended.

    • A stroke is a ingle unbroken movement made by an instrument

    • The technique is different for each type of instrument

    • It is important to remeber that instrumentation strokes are tiny, slow controlled movements

    • The working-end moves only a few mm with each strokes

  8. Check

Modified Pen Grasp

  • Dominant hand holds and activates the instrument

  • Pad of thumb and index finger grip the lower part fo the handle

  • Side of middle finger pad rests on the sank

  • Tip of third finger rests on tooth

  • Little finger should be relaxed

  • Non dominant hand supports the jaw and retracts soft tissues.

  • Thumb and index finger are opposite to each other at or near the junction of the handle and the shank.

  • Ring finger rests securely on the tooth and remains straight. It acts as a support beam for the hand and a fulcrum on which to turn the instrument

→ The index, middle and ring finger should be in control at least at one point

→ Provides stability and strength in the grasp

Fulcrum

  • Keep the ring finger straight

  • Finger tip supports the weight of the hand

Location

  • 1-4 teeth away fromt he tooth being worked on

  • Establish out of the line of fire

  • Rest on the incisal edge or occlusal surface

  • Never rest directly above the tooth surface being worked on

Types of Strokes

  • Horizontal

  • Oblique

  • Vertical

- Strokes should overlap

- Remove large supragingival deposits in sections

Wrist Action

  • Rotating the hand and wrist as a unit to provide the power for instrument stroke

  • Similar to the action of turning a door knob

  • Together the hand and wrist create more power to move the instruments

  • Causes the least amount of fatigue to the muscles of the hand and fingers

Avoid

  • Do not grip the instruments too tight

  • Finger rest ahould not be lifting off the tooth it is resting on

  • Avoid digit strokes

Wiping Off Instruments

  • Instruments become contaminatied with blood, saliva, plaque and calculus deposits

  • Wipe clean with a piece of guaze or cotton wool roll

  • Do not wipe between fingers or on gloves

  • Do not wipe on patient’s bib